子宫动脉栓塞术辅助中、晚孕期前置胎盘孕妇剖宫产引产

Uterine arterial embolization in induced labor by cesarean section for patients with placenta previa in second and third trimester

目的探讨子宫动脉栓塞术(UAE)辅助治疗前置胎盘中、晚孕期剖宫产引产的临床疗效及可行性。方法选择2012年5月至2016年1月,在徐州市中心医院接受剖宫产引产的56例中、晚孕期合并前置胎盘的孕妇为研究对象。根据孕妇及家属自主选择的引产手术方式,将56例孕妇分为介入组36例(UAE联合剖宫产术引产)和对照组20例(仅进行剖宫产术引产)。回顾性分析2组孕妇术中缩宫素使用量、手术时间、术中出血量、输血率及子宫切除率,术后2h出血量及24h总出血量,以及术后并发症发生情况的统计学差异。所有孕妇均签署知情同意书,并上报医院伦理道德委员会批准。结果 1 2组孕妇年龄、孕次、产次、孕龄及前置胎盘类型构成比比较,差异均无统计学意义(P>0.05)。2介入组孕妇手术时间、术中出血量、术后2h出血量及术后24h总出血量均显著短于或少于对照组,并且差异均有统计学差异(P<0.001);2组孕妇术中缩宫素使用量比较,差异无统计学意义(P>0.05)。3介入组孕妇术中输血率及子宫切除率,术后腹痛发生率、发热率及月经恢复率均显著低于对照组,并且差异有统计学意义(P<0.05);2组孕妇术后切口感染率比较,差异无统计学意义(P>0.05)。结论 UAE辅助治疗中、晚孕期前置胎盘剖宫产引产,可减少产后出血,保留子宫,减少术后并发症发生。

Objective To investigate the feasibility and effect of uterine artery embolization （UAE） in induced labor by cesarean section for patients with placenta previa in second and third trimester. Methods A total of 56 patients with placenta previa in second and third trimester who accepted induced labor from May 2012 to January 2016 in Xuzhou Central Hospital were chosen as study objects. According to the mode of induced labor by maternal and her family member＇s willing, the 56 patients were divided into interventional group （induction of labor by UAE and cesarean section,n=36） and control group （induction of labor by cesarean section, n=20）. A retrospective analysis of two groups were performed in the use of oxytocin, operation time, blood loss amount during operation, blood transfusion rate, uterine resection rate, postoperative 2 h bleeding amount, 24 h total bleeding amount and postoperative complications. This study was approved by the Ethical Review Board of Investigation in Human Being of Xuzhou Central Hospital. Informed consent was obtained from each participant. Results ① There were no significant differences between two groups in maternal age, gravidity, parity, gestational age, and constituent ratio of placenta previa type （P 〉0.05）. ② The operation time, bleeding amount during operation, postoperative 2 h bleeding amount and 24 h total bleeding amount of interventional group were shorter or lower than those of controlgroup, and the differences were statistically significant（P〈0.001） ; There was no significant difference between two groups in dose of oxytocin（P〉0.05）. ③ The rate of blood transfusion during operation, hysterectomy rate, postoperative abdominal pain rate, fever rate and menstrual recovery rate of interventional group were lower than those of control group, and the differences were statistically significant（P〈0.05） ; There was no significant difference between two groups in postoperative wound infection rate（P〉0.05）. Conclusions UAE in induced labor by cesarean section for patients with placenta previa in second and third trimester is effective in reducing postpartum hemorrhage,reserving uterus and reducing the postoperative complications.