双侧子宫动脉预留导管栓塞在凶险性前置胎盘伴胎盘植入中的应用

Prophylactic bilateral uterine artery catheterization and embolization in treatment of pernicious placenta previa and accreta

目的探讨双侧子宫动脉预留导管产后行子宫动脉栓塞术在凶险性前置胎盘伴胎盘植入剖宫产术中的应用价值。方法回顾性分析16例接受剖宫产联合双侧子宫动脉预置导管栓塞治疗的凶险性前置胎盘伴胎盘植入产妇的资料。记录术中出血量、输血量、子宫切除情况、透视时间、辐射剂量、并发症及新生儿情况。结果剖宫产联合双侧子宫动脉栓塞术的技术成功率为93.75%(15/16)。术中平均出血量(1 575.00±1 040.83)ml,平均输血量为(3.44±2.34)U悬浮少白细胞红细胞。胎儿娩出前平均透视时间(0.89±0.24)min,平均辐射剂量(7.17±2.12)mGy。1例新生儿出生后重度窒息,其余15名新生儿出生后5min Apgar评分为(9.38±0.89)分。1例产妇因术后因再次活动性出血并发弥漫性血管内凝血而行全子宫切除术。2例产妇术后感臀部疼痛。结论双侧子宫动脉预留导管产后行子宫动脉栓塞术可用于凶险性前置胎盘伴胎盘植入的治疗,有利于减少剖宫产术中出血及输血量,降低子宫切除的风险,且辐射剂量较低、术后并发症较少。

Objective To investigate the application value of prophylactic bilateral uterine artery catheterization and embolization in treatment of patients with pernicious placenta previa and accreta. Methods Data of 16 patients with pernicious placenta previa and accreta who underwent prophylactic bilateral uterine artery catheterization and uterine artery embolization and cesarean section were retrospectively analyzed. The amount of intraoperation blood loss, the amount of blood transfusion, cesarean hysterectomy rate, fluoroscopy operative time, radiation dose, complications and neonatal outcome were recorded. Results The technical success rate of the combined treatment was 93.75% （15/16）. The mean amount of blood loss was （1 575.00±1 040.83）ml. The mean amount of blood transfusion was （3.44±2.34）U leukoreduced red blood cells. The mean fluoroscopy operative time and radiation dose before delivery were （0.89±0.24）min and （7.17±2.12）mGy. One newborn was diagnosed as severe asphyxia. The mean Apgar score of another 15 newborns was （9.38±0.89） at 5 min after birth. One patient underwent hysterectomy due to postpartum hemorrhage complicated with disseminated intravascular coagulation. Buttock pain was found in 2 cases. Conclusion Prophylactic bilateral uterine artery catheterization and embolization can be used for the treatment of pernicious placenta previa and accreta. The combined treatment can control postpartum hemorrhage during placental dissection and reduce transfusion requirements and hysterectomy rate with few minor complications and low radiation exposure dose.