凶险型前置胎盘95例临床分析

Clinical analysis of 95 cases of pernicious placenta previa

目的探讨凶险型前置胎盘患者的高危因素和治疗方法。方法回顾我院2013年1月～2016年5月产科收治的95例凶险型前置胎盘的临床资料，将其分为植入组与非植入组，对比其子宫切除率等。将其中53例术前采用双侧髂内动脉预置球囊临时封堵术的患者（治疗组）与直接手术的42例患者（对照组）进行比较。结果（1）95例凶险型前置胎盘终止妊娠方式均采取剖宫产手术方法终止妊娠，并发胎盘植入26例，其中子宫切除切除16例（子宫切除率61．5％），非植入组69例，其中子宫切除切除5例（子宫切除率仅占7．2％），差异有统计学意义（P〈0．05）。（2）术前采用双侧髂内动脉预置球囊预置临时封堵术的治疗方法未能明显降低子宫切除率，差异无统计学意义（P〉0．05）。结论对于多次流产史、多次剖宫产史的凶险型前置胎盘产妇要警惕并发胎盘植入，并且凶险型前置胎盘并发胎盘植入产妇子宫切除率明显增高，术前采用双侧髂内动脉预置球囊预置临时封堵术的治疗方法有待进一步大样本探讨。

Objective To study the risk factors and treatment of pernicious placenta previa. Methods The clinical data of 95 cases of pernicious placenta previa in our hospital from January 2013 to May 2016 were restrospectively analyzed. They were divided into implanttation group and non-implantation group. The hysterectomy rate and others were compared. Among them, 53 cases of preset patients were treated with temporary occlusion of bilateral internal iliac artery balloon before operation for the （treatment group）, and 42 cases were were treated with directed operation. And they were compared. Results （1）95 cases of placenta previa terminated pregnancy were taken cesarean section operation method of termination of pregnancy, 26 cases were complicated with placenta accreta, and the uterus resection resection of 16 cases（hysterectomy was 61.5%）, non-implantation group of 69 cases, and the uterus resection resection in 5 cases（hysterectomy rate is only 7,2%）. The difference was significant（P 〈0.05）.（2）Preoperative balloon in within the bilateral iliac arteries can not reduce the uterus resection rate, and the difference was not significant （P 〉 0.05）. Conclusion For many times abortion history, the history of cesarean section maternal placenta previa, it is necessary to be alert to concurrent placenta implantation. And pernicious placenta previa combined with placenta increta uterus resection rate increased obviously. The method of preoperative treatment of temporary closure of bilateral internal iliac artery balloon operation needs further large sample to be discussed.