“一站式杂交技术”在凶险型前置胎盘治疗中的应用

Application of one-stage hybrid technique in treatment of pernicious placenta previa

目的:评价"一站式杂交技术"在凶险型前置胎盘患者治疗中的应用价值。方法:12例凶险型前置胎盘患者在杂交手术室同期行剖宫产和腹主动脉或髂内动脉球囊导管阻断(即杂交技术)。另外选择先在介入室预置髂内动脉球囊随后转手术室行剖宫产,术中充盈球囊阻断髂内动脉的12例凶险型前置胎盘病例作为对照组。术中严密观察血压、心率等血流动力学指标,比较两组手术时间、术中出血量、输血量、输液量、尿量、术后24 h内出血量、子宫切除率及新生儿情况等。结果:杂交手术组术中血压、心率等指标较对照组稳定,手术时间(72±8)min,术中出血量(620±95)mL、输血量(550±40)mL、输液量(1 850±160)mL、术后24 h内出血量(75±9)mL,均显著低于对照组(均P<0.05);两组术后均无严重并发症,新生儿出生时Apgar评分、体质量等指标比较差异无显著性(均P<0.05)。结论:"一站式杂交技术"对控制凶险型前置胎盘患者术中出血的作用明显,值得在有条件的医院推广。

Objective To assess the value of one?stage hybrid technique for treatment of perniciousplacenta previa.Methods12patients with pernicious placenta previa who had received simultaneously Cesareansection and temporary balloon occlusion of abdominal aorta or internal iliac artery in the hybrid operation room wereincluded in this study.12patients with pernicious placenta previa who had preserved balloon ducts in internal iliacartery before Cesarean section were chosen as a control group.Balloons were filled to control hemorrhage during theprocedure.The hemodynamic parameters including blood pressure and heart rate were monitored during the opera?tion.Surgical duration,amount of blood loss,amount of blood transfusion,volume of infusion,urine volumeduring the procedure,postoperative volume of blood loss within24hours,uterine hysterectomy rate and neonatalconditions were compared between the two groups.Results During the operation,the blood pressure and heartrate in hybrid group were more stable.The mean surgical duration was(72±8)min,the intraoperative meanamount of blood loss was(620±95)mL,the mean amount of blood transfusion was(550±40)mL,the meanvolume of infusion was(1850±160)mL,the mean amount of blood loss in24h after the operation was(75±9)mL in the hybrid group,which were significantly lower than those in the control group(P<0.05for all comparisons).No serious complications occurred in any of the two groups after the operation.There were no significant differencesin neonatal conditions between the two groups.Conclusions One?stage hybrid technique has an obvious effect inthe control of intraoperative bleeding in patients with pernicious placenta previa.It is worth popularizing in thehospital whose conditions are permitted.