髂内动脉球囊预置阻断术在凶险性前置胎盘伴胎盘植入中的应用

Application of DSA-guided balloon placement of bilateral internal iliac artery in patients with dangerous placenta previa and placenta implantation

目的探讨数字减影血管造影(DSA)引导下双侧髂内动脉球囊预置阻断术在凶险性前置胎盘伴胎盘植入患者中的应用价值。方法回顾性分析2016年1月至2018年1月贺州市人民医院产科收治的60例凶险性前置胎盘伴胎盘植入患者的临床资料,依据手术方式不同分为观察组(DSA引导下双侧髂内动脉球囊预置阻断术和剖宫产术治疗,n=40)和对照组(常规止血措施和剖宫产术治疗,n=20),比较两组患者的手术情况、新生儿结局、子宫切除率、术后并发症发生率,以及术后及出院后的随访情况。结果观察组患者术中出血量为(1264.15±248.29)mL,明显少于对照组的(2695.5±520.81)mL,手术时间、住院时间分别为(103.52±19.21)min、(6.13±1.48)d,明显短于对照组的(141.36±52.63)min、(8.31±1.30)d,差异均有统计学意义(P<0.05);观察组新生儿出生1 min、5 min、10 min Apgar评分分别为(7.14±0.15)分、(8.95±0.17)分、(9.94±0.21)分,明显高于对照组的(6.92±0.14)分、(8.10±0.15)分、(8.92±0.18)分,差异均有统计学意义(P<0.05);对照组患者的子宫切除率、术后并发症总发生率分别为45.0%、80.0%,明显高于观察组的12.5%、12.5%,差异均有统计学意义(P<0.05);术后6个月随访发现两组母婴结局均良好。结论DSA引导下双侧髂内动脉球囊预置阻断术应用于凶险性前置胎盘伴胎盘植入患者,在缩短手术时间、减少术中出血量、缩短产妇康复进程、改善新生儿健康状况、降低子宫切除率及术后并发症发生率方面较常规剖宫产术处理方法具有更积极的临床作用。

Objective To explore the application value of digital subtraction angiography(DSA)-guided balloon placement of bilateral internal iliac artery in the patients with placenta previa and placental implantation.Methods The clinical data of 60 patients of placenta previa with placenta implantation in Department of Obstetrics,Hezhou People's Hospital from January 2016 to January 2018 were analyzed retrospectively.According to the different surgical methods,the patients were divided into two groups:observation group(DSA-guided balloon placement and cesarean section,n=40)and control group(routine hemostasis and cesarean section,n=20).The results of operation,neonatal outcome,hysterectomy rate,postoperative complications,and follow-up after operation and discharge were compared.Results The intraoperative bleeding volume of the observation group was(1264.15±248.29)mL,which was significantly less than(2695.5±520.81)mL of the control group;the operation time and hospitalization time were(103.52±19.21)min,(6.13±1.48)d,respectively,which were significantly shorter than(141.36±52.63)min,(8.31±1.30 d)of the control group;the differences were statistically significant(P<0.05).The total rate of hysterectomy and postoperative complications in the control group were 45.0%and 80.0%,respectively,which were significantly higher than 12.5%,12.5%in the observation group(P<0.05).The 6-month follow-up showed that the results of both groups were good.Conclusion DSA-guided balloon placement of bilateral internal iliac artery has a more active clinical effect in shortening the operation time,reducing the amount of intraoperative bleeding,shortening the process of maternal recovery,improving the health status of newborn,and reducing the rate of hysterectomy and postoperative complications.