腹主动脉与髂内动脉球囊阻断在凶险性前置胎盘剖宫产术中应用对比研究

Abdominal aorta balloon occlusion vs internal iliac artery balloon occlusion in performing cesarean section for delivery women with pernicious placenta previa: a comparative study

目的对比研究双侧髂内动脉球囊阻断与腹主动脉球囊阻断在凶险性前置胎盘(PPP)剖宫产术中应用的临床疗效及安全性。方法 2015年9月至2017年9月对33例经彩色多普勒超声和/或MR诊断为PPP伴/不伴胎盘植入产妇剖宫产前行临时动脉球囊阻断术。随机分为两组,双侧髂内动脉球囊阻断17例(A组),腹主动脉球囊阻断16例(B组)。主要观察透视时间、辐射剂量、手术时间、术中出血量、新生儿Apgar评分及手术相关并发症。结果 33例均成功完成临时球囊阻断术。B组平均透视时间、辐射剂量、术中出血量均低于A组(P<0.05),两组间剖宫产时间、新生儿Apgar评分(1、5、10 min)差异均无统计学意义(P>0.05)。33例子宫均未切除,也未发生手术相关并发症。结论 PPP剖宫产术中双侧髂内动脉临时球囊阻断或腹主动脉临时球囊阻断,可有效减少术中出血量,降低子宫切除概率,但腹主动脉球囊阻断临床效果及辐射防护安全性较优于双侧髂内动脉球囊阻断。

Objective To compare the clinical efficacy and safety of bilateral internal iliac artery balloon occlusion in cesarean section with those of abdominal aorta balloon occlusion for delivery women with pernicious placenta previa（PPP）. Methods From September 2015 to September 2017, a total of 33 delivery women with Doppler ultrasound-proved and/or MRI-proved PPP accompanying with or without placenta implantation received prophylactic temporary artery balloon occlusion right before cesarean section. The 33 delivery women were randomly divided into group A（receiving bilateral internal iliac artery balloon occlusion,n =17） and group B（receiving abdominal aorta balloon occlusion, n =16）. The fluoroscopy time, radiation dose, time spent for operation, amount of intraoperative blood loss, neonatal Apgar score, and procedure-related complications were recorded. Results Successful temporary artery balloon occlusion was accomplished in all 33 delivery women. The mean fluoroscopy time, radiation dose and amount of intraoperative blood loss in group B were significantly lower than those in group A（P〈0.05）. No statistically significant differences in the time spent for cesarean section and in neonatal Apgar score（measured at 1 min, 5 min and 10 min）existed between the two groups（P〈0.05）. No hysterectomy was needed and no procedure-related complications occurred in all 33 delivery women. Conclusion In performing cesarean section for delivery women with PPP, the use of temporary bilateral internal iliac artery balloon occlusion or temporary abdominal aorta balloon occlusion can effectively reduce the amount of intraoperative blood loss and the hysterectomy rate. The abdominal aorta balloon occlusion is superior to bilateral internal iliac artery balloon occlusion in clinical effect and radiation protection safety.