腹主动脉球囊阻断术和子宫动脉栓塞术治疗瘢痕子宫合并前置胎盘植入的比较研究

Treatment of scarred uterus with placenta previa accreta by abdominal aorta balloon block and uterine artery embolizations

目的探讨腹主动脉球囊阻断术和子宫动脉栓塞术治疗瘢痕子宫合并前置胎盘植入的临床效果。方法选择2014年6月至2017年3月河北省任丘市华北石油总医院拟行剖宫产术的50例瘢痕子宫合并前置胎盘植入患者为研究对象。采用随机数字法,将其分为A、B两组,每组各包含25例患者,A组患者行腹主动脉球囊阻断术,B组患者行子宫动脉栓塞术。搜集患者及胎儿的一般资料、手术时间、术中出血量、输血量以及子宫动脉结扎、子宫切除情况;比较两组患者娩出新生儿的体重及Apgar评分;术后随访调查患者出院时间以及并发症情况。结果 A组受试者手术时间较B组受试者显著缩短(t=6.265,P<0.05),A组受试者术中出血量以及输血量均显著低于B组受试者(t值分别为5.741、6.095,均P<0.05)。A组受试者子宫动脉结扎率、子宫切除率分别为5.71%、14.29%,均显著低于B组的14.14%、25.71%(χ~2值分别为5.016、4.033,均P<0.05),A组受试者住院时间为(5.12±0.93)天,显著低于B组受试者的(6.96±1.12)天(t=2.149,P<0.05),两组受试者娩出新生儿的体重以及新生儿Apgar评分均不存在显著差异(t值分别为0.523、0.433,均P>0.05)。结论采用腹主动脉球囊阻断术治疗瘢痕子宫合并前置胎盘植入可明显缩短手术及住院时间,降低患者术中出血量与输血量,减少子宫动脉结扎、子宫切除的发生情况,临床效果优于子宫动脉栓塞术。

Objective To investigate the treatment of scarred uterus with placenta previa accreta by abdominal aorta balloon block and uterine artery embolizations.Methods Fifty cases of scarred uterus combined with placenta previa accreta receiving cesarean section in Renqiu Huabei Petroleum General Hospital of Hebei Province from June 2014 to March 2017 were selected as study subjects and divided into group A and group B by random number method,and 25 cases were in each group.Patients in group A were treated with abdominal aorta balloon block,and patients in group B were treated with uterine artery embolization.General information of patients and fetuses,operation time,intraoperative blood loss,blood transfusion volume,uterine artery ligation and hysterectomy were recorded.Neonatal weight and Apgar score were compared between two groups.Discharge time and complications of patients were followed up after operation.Results Average operation time of subjects in group A was significantly shorter than that in group B（t=6.265,P〈0.05）.Amounts of bleeding and blood transfusion during operation in group A were significantly lower than those in group B（t value was 5.741 and 6.095 respectively,both P〈0.05）.Uterine artery ligation and hysterectomy rates in group A were 5.71% and 14.29% respectively,which were significantly lower than those of 14.14% and 25.71%in group B（χ~2 value was5.016 and 4.033 respectively,both P〈0.05）.Time of hospitalization in group A was 5.12±0.93 d,which was significantly lower than that（6.96±1.12 d）in group B（t=2.149,P〈0.05）.There were no significant differences in neonatal birth weight and neonatal Apgar score in two groups（t value was 0.523 and 0.433 respectively,both P〈0.05）.Conclusion Treatment of scarred uterus with placenta previa accreta by abdominal aorta balloon block obviously shortens operation time and hospital stay,reduces intraoperative blood loss and blood transfusion amount,and reduces occurrences of uterine artery ligation and hysterectomy.Its clinical effect is better than that of uterine artery embolization.