临时腹主动脉球囊阻断在凶险性前置胎盘剖宫产术中的应用

Application of Temporary Balloon Occlusion of Abdominal Aortain Prevention of Bleeding during Cesarean Section in women with Pernicious Placenta Previa

目的探讨临时腹主动脉远端球囊阻断,在凶险性前置胎盘剖宫产术中的临床应用。方法 2015年8月1日-2015年11月30日,在新疆医科大学第一附属医院就诊的87例凶险性前置胎盘孕妇中,20例剖宫产术前行临时腹主动脉远端球囊置入。回顾性分析20例患者的临床资料作为球囊阻断组。从本队列未行球囊置入的孕妇中,依据年龄、孕周、流产次数、剖宫产次数、是否胎盘植入等因素,抽取20例患者作为对照组,两组在各因素间无统计学差异。观察两组术中出血量、子宫切除例数、术后再出血情况,并进行比较。同时记录球囊阻断组射线暴露时间及剂量,球囊置入相关并发症等情况。结果球囊阻断组20例患者,保留子宫19例,切除子宫1例,剖宫产术中平均出血量(1131.52±920)m L,术后再出血6例;对照组20例患者,保留子宫14例,切除子宫6例,剖宫产术中平均出血量(2170.59±1043)m L,术后再出血7例。球囊阻断组术中出血量、子宫切除例数均明显少于对照组(P<0.05),术后再出血例数无统计学差异。结论临时腹主动脉远端球囊阻断,可减少凶险性前置胎盘剖宫产术中出血量,降低子宫切除风险。

Objective To explore the clinical value of temporary balloon occlusion of the abdominal aorta for preventing intraoperative bleeding during cesarean for patients with pernicious placenta previa. Methods 87 women with pernicious placenta previa were delivered in the first affiliated hospital of Xinjiang Medical University from Aug 1,2015 to Nov 30,2015. Among them,20 cases whose clinical data were retrospectively analyzed as the balloon occlusion group,and accepted the temporary aortic balloon occlusion during cesarean section. Another 20 cases who did not accept balloon occlusion were chosen as the control group. There were no significant difference in ages,gestational weeks,frequency of abortion,frequency of cesarean section and placenta accrete. Blood loss during the operation,cases of uterus reserved,cases of re-blooding after cesarean section,the duration and dose of fetal radiation exposure,and complication of temporary balloon occlusion of abdominal aorta were analyzed. Results Uteruses were reserved in 19 cases in balloon occlusion group,while 14 cases in the control group. The mean blood loss in the operation was（1131.52±920）ml and re-blooding were observed in 6 cases in balloon occlusion group,while（2170.59±1043）ml blood loss and 7 cases re-blooding in the control group. There were significant difference in blood loss and uterus reserve rate between two groups,while no significant difference was recorded in re-blooding rate. Conclusion Temporary occlusion of the abdominal aorta might effectively reduce the blood loss during cesarean section as well as the risk of hysterectomy.