双介入技术在凶险型前置胎盘剖宫产中的临床应用

Clinical application of dual interventional technique in treating extremely dangerous placenta previa cesarean section

目的 探讨双介入技术在凶险型前置胎盘剖宫产中的安全性和有效性。方法 自2014年1月至2015年8月采用双介入技术治疗17例凶险型前置胎盘患者，17例均超声诊断为凶险型前置胎盘患者，在剖宫产术前行双侧髂内动脉球囊置入，待胎儿娩出脐带结扎后充盈球囊，剖宫产术后即拔出球囊及一侧导管鞘，12 h后如无再次出血给予拔出另外一侧导管鞘，如有出血，给予急症行子宫动脉栓塞术。记录剖宫产术中出血量，球囊置入X线曝光时间，球囊置入照射剂量，子宫切除情况，对胎儿有无影响等。结果 17例髂内动脉球囊置入均成功；17例患者中1例行子宫次全切除，1例行子宫次全切除加部分膀胱修补术，1例再次行子宫动脉栓塞术，其余14例术后均无出血；球囊置入X线曝光时间平均为120 s（最长时间为 200 s，最短时间为65 s），放射线剂量平均为20 mGy（15～35 mGy）；术中出血量平均为 1 600 ml（300~6 000 ml）； 所有胎儿术后均给予随访，至今未发现畸形等情况。结论 双介入技术不仅可减少凶险型前置胎盘剖宫术中出血量，同时大大降低了子宫切除风险。

Objective To evaluate the safety and efficacy of dual interventional technique in treating extremely dangerous placenta previa cesarean section. Methods A total of 17 patients with extremely dangerous placenta previa, who were admitted to authors＇ hospital to receive treatment with dual interventional technique during the period from January 2014 to August 2015, were included in this study. The diagnosis of extremely dangerous placenta previa was confilmed by ultrasonography in all 17 patients. Balloons were placed in bilateral iliac arteries before cesarean section was carried out. After the fetus was delivered and the umbilical cord was ligated, the balloons were filled up. The balloon and the catheter sheath of the same side were pulled out immediately after cesarean section was finished. Twelve hours later, if no re- bleeding occurred the catheter sheath of the other side could be pulled out, otherwise emergency uterine artery embolization had to be carriedout. The amount of blood loss during cesarean section, the X-ray exposure time and radiation dose for balloon placement, the result of hysterectomy, the influence on fetus, etc. were recorded. Results Successful bilateral iliac artery balloon implantation was accomplished in all 17 patients. Of the 17 patients, subtotal resection of the uterus had to be carried out in one, subtotal resection of the uterus together with partial repair of bladder in one, and second time of uterine artery embolization in one. In the remaining 14 patients no re-bleeding was observed. The mean X-ray exposure time for balloon placement was 120 s （65-200 s）; the mean radiation dose for balloon placement was 20 mGy （15-35 mGy） ; the mean amount of blood loss during cesarean section was 1 600 ml （300-6 000 ml）. All the neonates werefollowed up, and no abnormalities were observed so far. Conclusion Dual interventional technique not only can reduce the amount of blood loss during placenta previa caesarean section, but also can greatly reduce the risk of hysterectomy.