应用复合手术室治疗凶险性前置胎盘并胎盘植入的临床分析

Clinical efficacy of hybrid operation room for treatment of placenta previa complicated with placenta accrete

目的探讨应用复合手术室在凶险性前置胎盘并胎盘植入的治疗经验。方法回顾性分析应用复合手术室治疗30例凶险性前置胎盘并胎盘植入的产妇病例资料,手术方案采用“一站式”腹主动脉球囊阻断辅助剖宫产术。记录术中出血量、输血量、子宫切除例数、球囊阻断时间、孕妇接受射线剂量及相关并发症等。结果30例患者成功接受手术,29例术前置入球囊,1例行子宫切除术。18例出血量在500ml以内,500~1000ml5例,1000~1500ml3例,2000ml左右的2例,1例患者出血量约5000ml,平均出血量(843±934)ml。仅对术中出血大于2000ml的4例产妇给与输血,平均输注红细胞(2100±1321)ml。球囊阻断时间以及胎儿的平均辐射剂量分别为(20.4±5.2)min,(18.2±5.9)mGy。无产妇及胎儿死亡,无介入相关的严重并发症发生。结论应用复合手术室治疗凶险性前置胎盘并胎盘植入安全有效,能显著降低术中出血量及子宫切除率,是今后发展的方向。

Objective To explore the experience utilizing hybrid operating room for the treatment of placenta previa complicated with placenta accrete.Methods The clinical data of 30 patients with placenta previa complicated withplacenta accretetreated in hybrid operating room by"one-stage"abdominal aortic balloon occlusion as an auxiliary interventional procedure for cesarean section were analyzed retrospectively.The mount of blood loss and blood transfusion during cesarean section,the incidence of hysterectomia,the intraoperative balloon occlusion time,maternal radiation dose,and postoperative complications were recorded.Results Thirty patientssuccessfully underwent caesarean section,29 cases reserved balloon occlusion in abdominal aorta successfully,hysterectomy was performed in 1 case.Intraoperative haemorrhage amount were within 500 ml in 18 cases,500~1 000 ml in 5 cases,1 000~1 500 ml in 3 cases,about 2 000 ml in 2 cases,5 000 ml in 1 case,[mean(843±934)ml].Among the 30 cases,only 4 cases of intraoperativehaemorrhage amount larger than 2 000 ml needed blood transfusion,[mean(2 100±1321)ml].The intraoperative balloon occlusion time and fetal radiation dose were(20.4±5.2)minutes and(18.2±5.9)mGyrespectively.No serious maternal,infant and intervention-related complications occurred during and after the surgery.Conclusion Hybrid operating room provides a safe and effective method for treatment of placenta previa complicated with placenta accrete,It can significantly reduce theintraoperative bleeding and the risk of hysterectomy,which represents the future development and direction.