超声引导下腹主动脉下段球囊阻断术在凶险性前置胎盘剖宫产术中的应用

Application of lower abdominal aorta balioon occlusion technique by ultrasound guiding during caesarean section in patients with pernicious placenta previa

目的探讨超声引导下腹主动脉下段球囊临时阻断术在凶险性前置胎盘剖宫产术中应用的可行性及安全性。方法回顾性分析2015年1月至2017年8月广西柳州市工人医院收治的40例植入型凶险l生前置胎盘产妇的f临床资料。包括超声引导下腹主动脉球囊临时阻断术合并剖宫产术20例（研究组），常规剖宫产术20例（对照组）。对两组产妇的术中出血量、输血量、手术总时间、子宫切除率及并发症情况进行比较分析。结果研究组患者的术中出血量、输血量分别为（850±100）、（400±50）ml，明显低于对照组的（2500±230）、（1500±100）ml，差异均有统计学意义（t=35．624、16．523，均P〈0．05）。研究组患者的子宫切除率为5％，明显低于对照组的30％，差异有统计学意义（χ2=8．672，P〈0．05）。研究组患者的手术总时间为（2．0±0．5）h，明显短于对照组的（3．5±0．4）h，差异有统计学意义（t=11．362，P〈0．05）。研究组患者术中、术后均无手术相关并发症；对照组术中血压、心率、血氧明显波动，术后肾功能明显降低。结论剖宫产术前借助B超引导下行腹主动脉下段球囊临时阻断治疗凶险性前置胎盘可以有效控制术中出血，最大程度保留生育功能，技术安全、可行，且简便价廉，值得临床推广。

Objective To discuss the feasibility, effect and safety of lower abdominal aorta balloon occlusion technique by ultrasound guiding during caesarean section in patients with pernicious placenta previa. Methods The clinical data of 40 patients with pernicious placenta previa complicated with placenta accreta from January 2015 to August 2017 in Liuzhou workers hospital were analyzed retrospectively. The study group included 20 cases, which were operated in the way of cesarean section combined lower abdominal aorta balloon occlusion technique by ultrasound guiding, while the control group also included 20 cases, which were operated in the way of the conventional cesarean section without balloon occlusion technique. The bleeding amount, blood transfusion volume, operative total time, hysterectomy and complications of the two groups were compared. Results The bleeding amount and blood transfusion volume in study group were （ 850 ± 100） ml and （400 ± 50 ） ml, which were lower than that of the control group [ （ 2 500 ± 230 ） ml and （1 500 ±100）ml] ,the difference was statistically significant （ t = 35.624, 16. 523, all P 〈 0.05 ）. In addition,the hysterectomy rate in study group was 5%, which was lower than that in the control group （30%）, the difference was statistically significant （ χ2 = 8. 672, P 〈 0.05 ）. And the total time of operation was （2. 0± 0.5 ） h in the study group, which was shorter than that in the control group [ （3.5± 0.4） h ]. The difference was statistically significant （ t = 11. 362, P 〈 0.05 ）. No postoperative complications took place in the study group. The blood pressure, heart rate and blood oxygen fluctuated significantly, and the postoperative renal function was significantly reduced in the control group. Conclusions The lower abdominal aorta balloon occlusion technique by ultrasound guiding （luring a caesarean section in patients with pernicious placenta previa can effectively control the bleeding （luring operation, and preserve reprodu（＇tive fi, netion to the utmost degree. Therefore, the technique is safe, feasible, convenient and cheaper, and worthy of being widely applied in clinic.