Forgarty导管腹主动脉阻断联合子宫动脉栓塞在凶险型前置胎盘患者剖宫产术中的应用

Abdominal Aortic Occlusion by Forgarty Catheter Combined with Uterine Artery Embolization in Application of Cesarean Section for Patients with Pernicious Placenta Previa

目的观察应用Forgarty导管行腹主动脉阻断联合子宫动脉栓塞辅助剖宫产术治疗凶险型前置胎盘的效果及安全性。方法选取2016年3—11月于我院行剖宫产术的凶险型前置胎盘22例作为研究组,均于剖宫产术前行Forgarty导管预置术,待胎儿娩出后阻断腹主动脉再行子宫动脉栓塞术。另选取2015年1—12月我院行传统剖宫产术的凶险型前置胎盘28例作为对照组。回顾调查两组术中出血量、输血量、新生儿Apgar评分;球囊预置术中和子宫动脉栓塞术中电离辐射剂量;术后住院时间、是否入住重症监护病房(ICU)以及围术期并发症发生情况;术后随访3个月,观察月经恢复时间、产妇及新生儿有无放射相关性疾病。结果研究组21例取得满意的止血效果,1例发生术中大出血。两组术中出血量[(354.1±156.4)ml vs(2055.4±567.3)ml]、输红细胞悬液量[(0.7±0.3)U vs(4.2±2.8)U]、输注血浆量[(275.6±75.1)ml vs(890.6±245.1)ml]、手术总耗时[(78.2±25.5)min vs(133.4±29.2)min]、术后住院时间[(7.4±2.1)d vs(14.5±2.6)d]、子宫切除率(0 vs 32.14%)、术中大出血率(4.55%vs89.29%)、失血性休克率(0 vs 39.29%)、入住ICU率(0 vs 42.86%)比较差异均有统计学意义(P<0.05)。术后随访3个月,研究组均未出现严重并发症,未发生产妇及新生儿放射相关性疾病,仅2例出现臀部疼痛。结论应用Forgarty导管行腹主动脉阻断联合子宫动脉栓塞辅助剖宫产术治疗凶险型前置胎盘患者安全、有效,可明显降低术中、术后大出血的发生率,减少子宫切除等不良事件的发生。

total of 22 patients with pernicious placenta previa undergoing cesarean section from March to November 2016 were recruited as study group.Preoperative Forgarty catheterization was performed for all patients, and abdominal aorta was obstructed after fetal disengagement, and then uterine artery embolization was performed.Other 28 patients with pernicious placenta previa undergoing traditional cesarean section from January to December 2015 were selected as control group.Intraoperative blood loss volume, blood transfusion volume, neonatal Apgar score, radiation dose of ionizing radiation during Forgarty catherization and uterine artery embolization, postoperative length of stay, whether or not admission in ICU and perioperative incidence rate of complications were retrospectively investigated in two groups.With postoperative 3 months of follow-up, menstrual recovery time and incidence rates of radiation-related diseases in puerperal and neonatus were also observed.Results In study group, 21 patients had satisfactory hemostatic efficacy, while 1 patient had intraoperative hemorrhoea.In two groups, values of intraoperative blood loss volume were （354.1 ± 156.4） ml vs （2055.4 ± 567.3） ml;volume values of erythrocyte suspension consumption were （0.7 ± 0.3） U vs （4.2 ± 2.8） U;values of plasma consumption were （275.6±75.1） ml vs （890.6±245.1） ml;the total operative times were （78.2±25.5）min vs （133.4±29.2） min;postoperative length of stay were （7.4±2.1） d vs （14.5±2.6） d;hysterectomy rates were 0 vs 32.14%;admission rates in ICU were 0 vs 42.86%;intraoperative hemorrhoea rates were 4.55% vs 89.29%;hemorrhagic shock rates were 0 vs 39.29%, and the differences were statistically significant （P〈0.05）.In study group during postoperative 3 months of follow-up, no severe complications and radiation-related diseases in puerperal and neonatus were found, except that hip pain happened in 2 patients.Conclusion Abdominal aortic occlusion by Forgarty catheter combined with uterine artery embolization in assistance of cesarean section for patients with pernicious placenta previa is safe and effective, and it can significantly decrease incidence rates of postoperative hemorrhage and reduce incidence rate of adverse events such as hysterectomy.