不同介入方法治疗凶险性前置胎盘伴胎盘植入的疗效比较

Comparison of the clinical effect of different inter vention methods in the treatment of pernicious placenta previa with placenta accreta

目的比较子宫动脉栓塞术与腹主动脉球囊阻断术对凶险性前置胎盘伴胎盘植入的治疗效果。方法回顾性分析2015年6月~2016年12月我院收治的73例凶险性前置胎盘伴胎盘植入患者的临床资料,根据剖宫产术前采用的介入方法分为两组,采用子宫动脉栓塞术47例为A组,采用腹主动脉球囊阻断术26例为B组,比较两组的手术时间、术中出血量及输血量、新生儿Apgar评分、住院时间、子宫切除率、并发症发生率。结果 B组和A组相比较,手术时间缩短[(88.000±13.176)min vs(97.064±15.975)min,P<0.05],术中出血量减少[(870.385±188.223)ml vs(1260.000±459.035)ml,P<0.001],术中输血量减少[(331.539±203.896)ml vs(725.319±385.971)ml,P<0.001],住院时间缩短[(5.615±2.021)d vs(6.915±1.932)d,P<0.05]、子宫切除率降低(19.231%vs 42.553%,P<0.05)。两组的新生儿Apgar评分、并发症发生率比较差异均无统计学意义(P>0.05)。结论对于凶险性前置胎盘伴胎盘植入,腹主动脉球囊阻断术比子宫动脉栓塞术能更好的改善临床结局,具有缩短手术时间及住院时间、减少术中出血量及输血量、降低子宫切除率的优势。

Objective To compare the clinical effect of uterine artery embolization with abdominal aorta balloon occlusion in the treatment of pernicious placenta previa(PPP) complicated with placenta accreta. Methods A retrospective analysis was conducted in 73 cases of PPP complicated with placenta accreta admitted to our hospital during Jun 2015 and Dec 2016. Those cases were divided into two groups according to different interventional therapies before cesarean section. A group(n=47) underwent uterine artery embolization,while B group(n=26) received prophylactic abdominal aorta artery balloon placement before cesarean section. Operation time,the amount of blood loss and blood transfusion during operation,neonatal Apgar score,postoperative days,hysterectomy rate,the incidence of complications of two groups were compared. Results B group had shorter operation time [(88.000±13.176)min vs(97.064±15.975)min,P<0.05],less amount of blood loss during operation[(870.385±188.223)ml vs(1260.000±459.035)ml,P<0.001],less the amount of blood transfusion during operation[(331.539±203.896)ml vs(725.319±385.971)ml,P<0.001],shorter postoperative days [(5.615±2.021)d vs(6.915±1.932)d,P<0.05],lower hysterectomy rate(19.231% vs 42.553%,P<0.05). There was no statistical difference in neonatal Apgar score and the incidence of complications(P>0.05). Conclusion Abdominal aorta balloon occlusion has more significant clinical effect than uterine artery embolization in the treatment of PPP complicated with placenta accreta. It can effectively shorten operation time and postoperative days,reduce blood loss and blood transfusion during operation,decrease hysterectomy rate