磁共振成像辅助下腹主动脉球囊预置术在凶险性前置胎盘伴胎盘植入处理中的应用研究

Application of preoperative placement of abdominal aortic balloon with the assistance of MRI in the treatment of patients with pernicious placenta previa and placenta increta

目的探讨磁共振成像(MRI)辅助下腹主动脉球囊预置术在凶险性前置胎盘伴胎盘植入处理中的应用,寻求手术改进方案。方法回顾性分析2015年1月至2017年9月复旦大学附属妇产科医院收治的59例凶险性前置胎盘伴胎盘植入患者,其中研究组(n=27)在剖宫产术前行MRI检查,随后行腹主动脉球囊预置术,剖宫产术中胎儿娩出后充盈球囊暂时性阻断腹主动脉血供,然后再剥离胎盘;对照组(n=32)按照常规剖宫产术处理。结果 MRI测量低位肾动脉开口下缘与腹主动脉分叉的距离为(10.52±0.74)cm,其下方腹主动脉直径为(1.51±0.22)cm,介入术中X线透视时间(1.1±0.5)min。研究组与对照组相比,剖宫产术中出血量分别为(1086±248)m L及(1616±370)m L,输血量分别为(647±81)m L及(896±93)m L,差异有统计学意义(P<0.05)。两组子宫切除数、新生儿Apgar评分比较,差异无统计学意义(P>0.05)。结论 MRI辅助下放置腹主动脉球囊,可减少凶险性前置胎盘伴胎盘植入剖宫产术中出血量及输血量,不能降低子宫切除率。

Objective To investigate the application value of preoperative placement of abdominal aortic balloon with the assistance of MRI in patients with pernicious placenta previa and placenta increta, and to explore the surgical improvement program.Methods A retrospective analysis was performed in 59 cases of pernicious placenta previa with placenta increta admitted to Obstetrics and Gynecology Hospital of Fudan University from January 2015 to September 2017 ： the observation group （n=27）received MRI before cesarean section and then were placed abdominal aorta balloon.During the cesarean section, the ballon was temporarily expanded to stop the blood supply of abdominal aorta after the baby was delivered, and then the placenta was removed, while the control group （n=32）received conventional hemostatic method during cesarean section.Results The distance between lower renal artery opening and abdominal aortic bifurcation was measured as （10.52±0.74）cm and the diameter of the abdominal aorta below lower renal artery opening was measured as （1.51±0.22） cm.The radiography time in intervention was recorded as （1.1±0.5）min.The volume of blood loss and blood transfusion in the observation group [ （1086±248）, （647±81 ）mL ] was less than that in the control group [ （1616±370）, （896±93） mL], the difference being statistically significant （P〈0.05）.There was no significant difference between the two groups in the number of hysterectomy and neonatal Apgar score （P〉0.05）.Conclusion Preoperative placement of abdominal aortic balloon with the assistance of MRI is effective in reducing intraoperative blood loss and transfusion but have no effect in reducing the uterus resection in the treatment of pernicious placenta previa with placenta increta.