剖宫产术前行子宫动脉置管术在分娩后即刻行栓塞术联合米非司酮在凶险性前置胎盘中的应用

Application of Uterine Artery Catheterization before Cesarean Section and Embolization Combined with Mifepristone after Delivery in Pernicious Placenta Previa

目的:探究剖宫产术前行子宫动脉置管术且在胎儿娩出后即刻行栓塞术联合米非司酮在凶险性前置胎盘治疗中的临床价值。方法:回顾性分析2017年2月-2018年6月本院收治的65例凶险性前置胎盘患者的临床资料。所有患者术前均经米非司酮处理,其中剖宫产术前行子宫动脉置管术且在胎儿娩出后即刻行栓塞术的有33例,记为A组;剖宫产术后行子宫动脉置管术中栓塞术的有32例,记为B组。对比两组手术相关指标与不良事件发生率。结果:A组栓塞术耗时与剖宫产手术耗时明显短于B组(P<0.05),剖宫产手术失血量明显少于B组(P<0.05);A组弥漫性血管内凝血率、子宫切除率及晚期产后出血率均明显低于B组(P<0.05),两组新生儿窒息率比较,差异无统计学意义(P>0.05)。结论:相较于剖宫产术后行子宫动脉置管术中栓塞术联合米非司酮治疗凶险性前置胎盘,剖宫产术前行子宫动脉置管术且在胎儿娩出后即刻行栓塞术联合米非司酮可缩短栓塞术与剖宫产手术耗时,减少剖宫产出血量与弥漫性血管内凝血、子宫切除、晚期产后出血发生率。

Objective:To investigate the clinical value of uterine artery catheterization performed before caesarean section and embolization performed immediately after delivery combined with Mifepristone in the treatment of pernicious placenta previa.Method:The clinical data of 65 patients with pernicious placenta previa in our hospital from February 2017 to June 2018 were analyzed retrospectively.All patients were treated with Mifepristone before surgery.Among them,uterine artery catheterization was performed before cesarean section and performed embolization immediately after delivery in 33 cases as group A.There were 32 cases of embolization during uterine artery catheterization after cesarean section as group B.The incidence of surgical related indicators and adverse events in two groups were compare.Result:The embolization time and cesarean section time of group A were significantly lower than those of group B(P<0.05).The amount of blood loss during cesarean section was significantly lower than that of group B(P<0.05).The incidence of diffuse intravascular coagulation,hysterectomy rate and late postpartum hemorrhage rate in group A were significantly lower than those in group B(P<0.05).There was no significant difference in the rate of neonatal asphyxia between two groups(P>0.05).Conclusion:Compare with embolization during uterine artery catheterization after cesarean section combined with Mifepristone in the treatment of sinister placenta previa,the uterine artery catheterization before cesarean section and embolization immediately after delivery combined with Mifepristone can shorten the time spent on embolization and cesarean section,reduce the amount of cesarean section bleeding and the incidence of disseminated intravascular coagulation,hysterectomy,late postpartum hemorrhage.