不同设备引导下动脉临时球囊阻断技术在凶险性前置胎盘剖宫产术中的临床应用

Clinical Application of Different Devices Guided Arterial Temporary Balloon Occlusion Technique in Dangerous Placenta Previa Caesarean Delivery

目的探讨不同设备引导下动脉临时球囊阻断技术在前置胎盘剖宫产术中疗效评定及特点。方法收集昆钢医院放射科自2016年7月至2018年8月配合产科、超声科开展不同设备引导下临时球囊阻断患者共26例。26例患者均经超声和(或) MRI诊断凶险性前置胎盘,在不同的引导设备下行双侧髂内或髂总动脉预埋临时球囊,待胎儿取出时立即充盈球囊阻断髂动脉血流,根据产科手术进度及出血情况适时撤出球囊。结果本组26例患者动脉临时球囊预埋阻断均获得成功,其中1例患者因发现右侧子宫动脉假性动脉瘤形成,行栓塞治疗。26例患者阻断时间3～15 min,术中出血量400～1 000 m L。病例无子宫切除及术后输血,所有新生儿均存活。结论针对凶险性前置胎盘患者在剖宫产术中行动脉临时球囊阻断,能够减少剖宫产术中出血量及相关并发症的发生率。该技术具有创伤小、安全性高、疗效确切等特点,近年来已在临床推广应用。

Objective To discuss the characteristics and efficacy evaluation of the different devices guided arterial temporary balloon occlusion technique in dangerous placenta previa caesarean delivery. Methods The patients who had visited obstetrics department as total 26 were collected from July 2016 to August 2018. All patients were diagnosed as dangerous placenta previa by ultrasound or(and) magnetic resonance imaging(MRI) and had been received the arterial temporary balloon occlusion pre-caesarean delivery. Guided with different devices,the balloon was pre-embedded in the bilateral internal or common iliac artery. Immediately blocked the blood flow of iliac artery after the fetal delivered. Withdrawn the balloon according to the obstetric operation progression and bleeding.Results All the 26 patients were succeful in the arterial temporary balloon pre-embedded, and 1 patient of which taken embolotherapy 1 patient due to pseudo-aneurysm formation of right uterine artery. The occlusion time was about 3-15 mins while the intra-operation bleeding amount was about 400-1000 m L in all the patients. There was no hysterectomy or post-operative blood transfusion. All the newborns were survival. Conclusion The arterial temporary balloon occlusion technique in dangerous placenta previa caesarean delivery can decrease the amount of bleeding during the caesarean delivery and the incidence of related complication. It has advantages such as micro-invasion, strong safety and curative effect,and has been widely used in clinic.