腹主动脉球囊封堵序贯子宫动脉栓塞术在凶险性前置胎盘并胎盘植入剖宫产中的应用

The clinical application of abdominal aortic balloon occlusion followed by uterine artery embolization in the treatment of pernicious placenta previa complicated with placenta accreta during cesarean section

目的:探讨腹主动脉球囊封堵序贯子宫动脉栓塞在凶险性前置胎盘并胎盘植入剖宫产术中的临床应用效果。方法:回顾性分析我院2013年1月—2016年12月收治的512例凶险性前置胎盘并胎盘植入患者的资料。所有患者均于剖宫产前行腹主动脉球囊植入,62例患者行双侧子宫动脉栓塞术,其中4例患者术中发现胎盘植入宫颈口,剥离胎盘后因无法缝合遂填塞纱布条暂时按压止血,缝合子宫后紧急序贯双侧子宫动脉栓塞术;58例患者在胎盘剥离结束,缝合子宫后按压宫底,仍可见活动性出血,遂紧急序贯双侧子宫动脉栓塞术。分析62例行腹主动脉球囊封堵序贯子宫动脉栓塞术患者的临床效果及并发症情况。结果:512例患者中450例术中及术后未发生大出血,只行腹主动脉球囊封堵,未行子宫动脉栓塞;62例患者因术中或术后出血紧急序贯行双侧子宫动脉栓塞术,均保全了子宫。62例患者术中出血量900~3000 ml,平均1500 ml;输血量350~1600 ml,平均940 ml。胎儿透视时间3~8s,平均5s,受射线照射量为(4.2±2.9)mGy,胎儿Apgar评分均正常。随访期间未发现术中及术后的严重相关并发症。结论:对于单纯行剖宫产联合腹主动脉球囊封堵术后仍有活动性出血的凶险性前置胎盘并胎盘植入的患者,序贯子宫动脉栓塞术可有效降低术中的出血量和输血量,并能有效降低子宫切除的风险。

Objective:To investigate the clinical effects of abdominal aortic balloon occlusion followed by uterine artery embolization in the treatment of pernicious placenta previa complicated with placenta accrete during cesarean section.Methods:A retrospective analysis of clinical data of512patients who suffered from pernicious placenta previa complicated with placenta accreta and received treatment in our hospital from January2013to December2016was carried out.All patients underwent abdominal aortic balloon implantation before cesarean section.62patients received bilateral uterine artery embolization,among them,the placenta accreta was found at the opening of the cervix in4cases.Due to the difficulty to suture after the removal of the placenta,gauze packing was used to compress hemorrhage temporarily.As soon as the uterus was sutured,emergent bilateral uterine artery embolization was performed.In the other58cases,there was still active bleeding when pressing the lower part of the uterus after the placenta was removed and the uterus was sutured,so bilateral uterine artery embolization was performed urgently.This study aims to investigate the clinical effects and complications of the62patients who received abdominal aortic balloon occlusion followed by uterine artery embolization.Results:Of all512patients,450patients received only abdominal aortic balloon occlusion;62patients underwent emergent bilateral uterine artery embolization additionally due to hemorrhage during or after the C-section.No hysterectomy was performed.Of the62patients,the amount of bleeding was900~3000ml with an average of1500ml during the operation;the volume of blood transfusion was350~1600ml with an average of940ml.Fetal fluoroscopy time was3~8s with an average of5s.The dose of received radiation exposure was(4.2±2.9)mGy.Fetal Apgar score was normal.No serious complications were observed during and after the operation in follow-up visits.Conclusion:For patients with pernicious placenta previa complicated with placenta accreta and suffering from active bleeding after cesarean section and abdominal aortic balloon occlusion,bilateral uterine artery embolization can effectively reduce blood loss and blood transfusion during the operation,as well as lower the risk of hysterectomy.