腹主动脉球囊预置术与髂内动脉球囊预置术在植入型凶险性前置胎盘治疗中的比较研究

The Comparative Study in Perioperative Temporary Balloon Occlusion of the Distal Abdominal Aorta and Perioperative Temporary Balloon Occlusion of the Internal Iliac Arteries in the Therapy of Patients with Placenta Accreta

目的:比较研究腹主动脉球囊预置术与髂内动脉球囊预置术在植入型凶险性前置胎盘治疗中的临床疗效。方法:选择2014年1月至2015年4月住院治疗的植入型凶险性前置胎盘患者64例,随机分为两组,择期剖宫产术前行腹主动脉球囊置管32例(腹主动脉组)和双侧髂内动脉球囊置管32例(髂内动脉组),观察比较两组孕妇术中、术后情况及新生儿出生和婴儿期生长发育情况。结果:两组患者在手术时间、术中出血量、术后最高体温、输血率、子宫切除率、住院时间、球囊预置术后穿刺部位出血率、感觉障碍发生率、新生儿Apgar评分、新生儿身高、出生体质量等方面比较,差异均无统计学意义(P>0.05);而腹主动脉组球囊预置时间、透视时间、放射剂量均显著低于髂内动脉组(P<0.05)。术后1年内随访,两组婴儿在42天、3个月、6个月、1年的体质量及身高情况比较,差异均无统计学意义(P>0.05)。结论:腹主动脉球囊预置术与髂内动脉球囊预置术在植入型凶险性前置胎盘的治疗中均能安全、有效减少术中出血。而腹主动脉球囊预置术X线暴露时间更短、预判效果无需造影剂,对母胎保护性更强,可在临床推广。

Objective：To compare the therapeutic effect between perioperative temporary balloon occlusion of the distal abdominal aorta and perioperative temporary balloon occlusion of the internal iliac arteries in patients with invasively pernicious placenta previa. Methods：From January 2014 to April 2015,64 pregnant patients with placenta accreta were randomly assigned into two groups,and undergoing elective cesarean section 32 patients with temporary balloon occlusion of the distal abdominal aorta were in distal abdominal aorta group ,while other 32 patients with temporary balloon occlusion of the internal iliac arteries were in internal iliac arteries group. Clinical data of the 2 groups were analyzed and comparative studies of intraoperative and postoperative measures, neonatal and infant growth and development between the 2 groups were performed. Results.There were no significant differences in the operation time ,amount of bleeding during operation ,the maximum body temperature after operation ,the ratio of blood transfusion and hysterectomy,the hospitalized time,the bleeding ratio of puncture po- sition, the ratio of sensory disturbance after puncture, neonatus apgars score, lengths and weights, P 〉 0.05. distal abdominal aorta group were significant lower than internal iliac arteries group in the saccule insertion time,the radiation time and the radiate dose, P 〈 0.05. During the 1-year postoperative follow-up, the 42 d and 3,6,12 months infancy＇s heights and weights between two groups showed no significant differences（ P 〉 0. 05）. Conclusions;The data suggested that both the perioperative temporary balloon occlusion of the distal abdominal aorta and perioperative temporary balloon occlusion of the internal iliac arteries in the therapy of patients with placenta accreta were safe and effectivly decreased the loss of blood volume, but the perioperative temporary balloon oc- clusion of the distal abdominal aorta manipulates easier, faster, gets lower X-ray exposure time, and needs no contrast agents,so it may get more protection of mother and fetus. And it could be extended in clinical practice.