178例凶险性前置胎盘伴胎盘植入保留子宫手术方式探讨

Discussion on Preserving Uterus Operation Mode of 178 Patients with Pernicious Placenta Previa and Placenta Accreta

目的:探讨降低凶险性前置胎盘伴胎盘植入出血风险和保留子宫的手术方式。方法:回顾性分析2015年4月—2017年11月在河南省人民医院进行手术的凶险性前置胎盘伴胎盘植入患者178例,根据患者的具体情况,采用相应的手术方式,包括双侧子宫动脉上行支结扎、宫颈提拉式缝合、子宫下段前壁部分切除、子宫下段双切口、宫腔球囊填塞以及腹主动脉球囊阻断等。结果:178例患者术中出血量为1 500(1 421.5,1 757.7)mL,其中未行腹主动脉球囊阻断者156例,术中出血量为1 600(1 461.3,1 707.2)mL;行腹主动脉球囊阻断者22例,术中出血量为1 800(1 761.9,1 912.7)mL,两者比较差异无统计学意义(Z=2.13,P=0.98);92例行Bakri球囊填塞术和86例未行宫腔填塞术患者术后感染发生率分别为23.9%(22/92)和18.6%(16/86),差异无统计学意义(χ~2=0.75,P=0.39)。1例患者因胎盘广泛植入切除子宫,所有患者均康复出院。结论:采用多种手术方式治疗凶险性前置胎盘伴胎盘植入患者,降低了术中出血量,多数子宫得以保留,取得了较好的治疗效果。

Objective:To investigate the preserving uterus operation mode and improve prognosis with pernicious placenta previa and placenta accreta.Methods:The clinical data of 178 patients with placenta previa and placenta accreta admitted to Henan provincial people′s Hospital,from April 2015 to November 2017 were analyzed retrospectively.According to the situation in the operation,patients underwent caesarean section,cerclage with tourniquet,ligation of ascending branch of uterine artery,cervical lifting suture,partial resection of anterior portion of lower uterine,double incision of lower uterine,stuffing with intrauterine balloon,and temporary aortic balloon of the abdominal aorta.Results:The mean blood loss of all 178 patients was 1 500(1 421.5,1 757.7)mL.The mean blood loss of 156 patients had not temporary aortic balloon of the abdominal aorta was 1 600(1 461.3,1 707.2)mL,the blood loss of 22 patients had temporary aortic balloon of the abdominal aorta was mean 1 800(1 761.9,1 912.7)mL,there was no statistical significance(Z=2.13,P=0.98).The incidence of postoperative infection of intrauterine balloon and those without intrauterine balloon was 23.9%(22/92)vs.18.6%(16/86),there was no statistical significance(χ2=0.75,P=0.39).1 patient was treated with hysterectomy due to extensive placenta accrete.All patients were restored to health and discharged.Conclusions:A variety of surgical procedures were applied to the treatment of placenta previa and placenta accreta,which reduced the amount of bleeding during operation.Most of the uterus was retained,and achieved good results.