凶险型前置胎盘合并胎盘植入行腹主动脉与双侧髂内动脉球囊阻断术的效果及妊娠结局分析

The effect of balloon occlusion of abdominal aorta and bilateral internal iliac artery in women with perilous placenta previa combined with placenta implantation and its influence on the pregnant outcomes

目的:探讨腹主动脉与双侧髂内动脉球囊阻断术对凶险型前置胎盘合并胎盘植入术效果及妊娠结局的影响。方法:回顾性收集本院2015年4月—2016年9月治疗的凶险型前置胎盘合并胎盘植入患者,采用双侧髂内动脉球囊阻断术(髂内动脉组)43例;2016年10月~2017年12月采用腹主动脉球囊阻断术(腹主动脉组)50例。观察两组胎盘植入类型、手术情况及下肢血栓、弥散性血管内凝血(DIC)发生率,记录妊娠结局。结果:两组的胎盘植入类型及DIC发生、下肢血栓对比未见差异(P>0.05);腹主动脉组的手术失血量、输血量、手术时间、子宫切除均低于髂内动脉组(P<0.05);两组的新生儿畸形、新生儿体重、新生儿Apgar评分、新生儿窒息等对比未见差异(P>0.05)。结论:腹主动脉球囊阻断术能降低凶险型前置胎盘合并胎盘植入患者的子宫切除率,减少手术时间,有助于改善妊娠结局。

Objective：To explore the effect of balloon occlusion of abdominal aorta and bilateral internal iliac artery in women with perilous placenta previa combined with placenta implantation and its influence on the pregnant outcomes.Methods：A retrospective analysis was conducted.43 patients with placenta previa and placenta accreta from April 2015 to September 2016 were in internal iliac artery group,who had experienced bilateral iliac artery balloon occlusion.50 patients with placenta previa and placenta accreta from October 2016 to December 2017 were in abdominal aorta group,who had experienced abdominal aorta balloon occlusion.The type of placenta implantation,volume of operative blood lost,blood transfusion volume,operative time,the incidence of hysterectomy,lower extremity thrombosis and disseminated intravascular coagulation （DIC） were observed in both groups.The pregnant outcomes were also recorded.Results：There was no significant different in the type of placenta implantation and the incidence of DIC and lower limb thrombosis between the two groups （P＞0.05）.The volume of blood lost,volume of blood transfusion,operation time and rate of hysterectomy of patients in the abdominal aorta group were significant lower than those of patients in the internal iliac artery group （P ＜ 0.05）.There were no significant different in neonatal malformation,newborn weight,neonatal Apgar score,and neonatal asphyxia between the two groups of （P＞0.05）.Conclusion：Abdominal aortic balloon occlusion can reduce the hysterectomy rate,can reduce operative time,and can improve pregnant outcomes of patients with placenta previa and placenta accreta.