广泛前壁凶险性前置胎盘腹主动脉球囊阻断时机与子宫切口的选择

Timing of balloon occlusion of abdominal aorta and the choice of uterine incision in cesarean section for pregnant women with pernicious placenta previa and extensive anterior wall placenta

目的探讨广泛前壁凶险性前置胎盘患者行剖宫产时腹主动脉球囊阻断时机与子宫切口的选择。方法选取24例实施腹主动脉球囊预置下剖宫产术的广泛前壁凶险性前置胎盘患者的临床资料,均为择期剖宫产,术前超声及磁共振评估胎盘植入子宫肌层但未穿透浆膜层。根据腹主动脉球囊阻断时机与子宫切口的不同分为两组,胎儿娩出前球囊阻断加子宫下段横切口组(A组)11例,子宫底部横切口娩出胎儿后球囊阻断组(B组)13例。比较两组术前、术中、术后母体及新生儿的情况。结果A组腹壁切口长度短于B组,术中出血量、术后住院日均少于B组,差异均有统计学意义(均P<0.05)。两组手术时间、腹主动脉球囊阻断时间、产后出血发生率、子宫动脉栓塞率、子宫切除率、腹壁切口愈合不良发生率以及新生儿体重、新生儿1、5min Apgar评分、新生儿转新生儿重症监护中心比例比较差异均无统计学意义(均P>0.05)。结论广泛前壁凶险性前置胎盘患者行剖宫产时,在切开子宫前用球囊阻断腹主动脉并选择子宫下段横切口效果更好。

Objective To investigate the timing of balloon occlusion of abdominal aorta and the choice of uterine incision in cesarean section for women with pernicious placenta previa and extensive anterior wall placenta.Methods The clinical data of 24 pregnant women with pernicious placenta previa and extensive anterior wall placenta undergoing caesarean section with abdominal aortic balloon were retrospectively analyzed.Preoperative ultrasound and magnetic resonance imaging were used to evaluate the placenta implanted into the uterine myometrium but did not penetrate the uterine serosa.According to the different timing of abdominal aortic balloon occlusion and the different incision of uterus,these cases were divided into two groups.There were 11 cases(group A)delivered through transverse incision of lower uterine segment after abdominal aortic balloon occlusion;and 13 cases(group B)had abdominal aortic balloon occlusion after delivery through transverse incision of uterine fundus.The preoperative,intraoperative and postoperative maternal and neonatal conditions were compared between the two groups.Results The incision length of abdominal wall,intraoperative bleeding volume and hospitalization days in group of antenatal balloon occlusion were significantly less than those in group of postpartum balloon occlusion(P<0.05).There was no significant difference between the two groups in the operation time,duration of abdominal aortic balloon occlusion,and incidence of postpartum hemorrhage,uterine artery embolism and hysterectomy,abdominal incision healing,neonatal weight,1min Apgar score,5min Apgar score,and neonatal intensive care unit conversion rate(P>0.05).Conclusion It is more effective to apply the abdominal aortic balloon occlusion before uterine incision and chose the transverse incision of lower uterine segment during cesarean section for pregnant women with pernicious placenta previa and extensive anterior wall placenta.