凶险性前置胎盘伴胎盘植入剖宫产术中应用髂内动脉球囊阻断术38例临床分析

Clinical Analysis of Internal Iliac Arteries Balloon Occlusion in Cesarean Section in Treatment of Pernicious Placenta Previa with Placenta Accreta

目的:评估髂内动脉球囊阻断术在凶险性前置胎盘伴胎盘植入患者剖宫产术中的意义。方法:回顾性分析四川大学华西第二医院2012年3月至2015年10月81例凶险性前置胎盘伴胎盘植入患者的临床资料,将剖宫产术中应用髂内动脉球囊阻断术的患者列入研究组(n=38),未使用者列入对照组(n=43),比较两组在剖宫产术中的出血量、输红细胞量、手术时间、新生儿窒息率、子宫切除率、术后住院时间等指标。结果:研究组术中出血量中位数为1650 ml(500~7800 ml),对照组为2000 ml(1000~12800 ml),两组比较差异有统计学意义(P<0.05);研究组术中输入红细胞量中位数为3.0 U(0~18.0 U),对照组为6.0 U(0~27.0 U),两组比较差异有统计学意义(P<0.05)。两组患者在手术时间、新生儿窒息率、术后住院时间及子宫切除率方面比较差异均无统计学意义(P>0.05)。子宫全切球囊组与子宫全切对照组在术中出血量、输红细胞量、手术时间、术后住院时间比较,差异均无统计学意义(P>0.05)。结论:凶险性前置胎盘伴胎盘植入患者剖宫产术中采用髂内动脉球囊阻断术可以减少术中出血量及输红细胞量,但不能降低子宫切除率。

Objective： To explore the therapeutic effect of prophylactic balloon occlusion of the internal iliac arteries in cesarean delivery in the management of pernicious placenta previa with placenta accreta.Methods： A total of81 patients diagnosed of pernicious placenta previa with placenta accreta in our hospital between March 2012 and October 2015 were retrospectively analysed.The patients were divided into study group（ n = 38,receiving routine cesarean section followed prophylactic balloon occlusion of the internal iliac arteries） and control group（ n = 43,receiving routine cesarean section）.The following clinical parameters were compared in two groups： estimated blood loss,transfused blood products,operating duration,postoperative hospital days.Results： The estimated blood loss was 1650 ml（ 500-7800 ml） in study group and 2000 ml（ 1000-12800 ml） in control group,with a statistically significant difference（ P〈0. 05）.The volume of transfused red blood cells was 3. 0 U（ 0-18. 0 U） in study group and6. 0 U（ 0-27. 0 U） in control group,with a statistically significant difference（ P〈0. 05） between two groups.No statistical difference was observed in term of postoperative hospital days,the rate of neonatal asphyxia and operating duration.In the two subgroups of hysterectomy of 31 cases,no statistical difference was observed in any outcomes evaluated（ P〉0. 05）.Conclusions： Prophylactic balloon occlusion of the internal iliac arteries is an alternative method to control postpartum haemorrhage in treatment of pernicious placenta previa. However,it might not decrease the incidence of hysterectomy.