中孕期瘢痕子宫胎盘前置并胎盘穿透性植入12例临床分析

Clinical analysis of 12 cases of scar uterus,placenta previa and placenta penetrating implantation in the second trimester

目的探讨中孕期瘢痕子宫胎盘前置状态并胎盘穿透性植入子宫下段部分切除术的临床应用价值。方法回顾性分析甘肃省妇幼保健院2013年4月至2018年4月收治的因胎死宫内或胎儿畸形要求终止妊娠的12例中孕期瘢痕子宫胎盘前置状态并胎盘穿透性植入患者的临床资料和子宫下段部分切除术的治疗效果。结果 12例患者均成功保留子宫,其中10例术前行介入双侧子宫动脉栓塞术(uterine artery embolization,UAE)及盆腔侧支动脉血管栓塞术,2例直接行子宫下段部分切除术,1例介入双侧UAE后行利凡诺引产胎盘未娩出,再次行胎盘植入组织及子宫下段部分切除术。术后3月复查B超子宫复旧良好,无发热、再次出血、子宫切口愈合不良等并发症发生。结论子宫下段部分切除术是中孕期瘢痕子宫胎盘前置状态并穿透性胎盘植入孕妇有效的治疗方式,预防性应用UAE可有效减少术中出血,提高手术成功率,降低子宫切除率。

Objective Explore the clinical value of partial hysterectomy in pregnant women with placenta previa and penetrating placenta implantation during second trimester.Methods A retrospective analysis of the clinical data that requiring termination of pregnancy because of fetal death intrauterine or fetal malformation in Gansu Provincial Maternal and Child Health Hospital from April 2013 to April 2018,and the effect of partial hysterectomy in patients with placenta previa and penetrating placenta implantation in 12 cases.Results In the 12 patients,the uterus was successfully retained,of which 10 underwent bilateral uterine arterial embolization(UAE)and pelvic collateral artery embolization,2 cases were directly underwent partial hysterectomy,1 case underwent failure of placenta delivery after UAE and induction of labor with Ethacridine Lactate,the placenta implantation tissue and the partial hysterectomy were performed.3 months after the operation,no subinvolution of uterus,no fever,no bleeding,no poor healing of uterine incision and other complications occurred.Conclusion Partial hysterectomy is an effective treatment for pregnant women with placenta previa and penetrating placenta implantation during second trimester,and prophylactic application of UAE can effectively reduce intraoperative bleeding,improve the success rate of surgery and reduce the rate of hysterectomy.