髂内动脉球囊阻断术在凶险性前置胎盘治疗中的应用

Application of Internal Iliac Arteries Balloon Occlusion in Treatment of Pernicious Placenta Previa

凶险性前置胎盘(pernicious placenta previa,PPP)易导致突发难治性大出血,近年来介入治疗广泛应用于PPP,减少了剖宫产术中出血量,降低了子宫切除率。介入治疗主要包括球囊阻断术和动脉栓塞术,其中髂内动脉球囊阻断术能有效预防和减少PPP剖宫产术中出血,将抢救性治疗转变为预防性治疗。国内外研究持续探索髂内动脉球囊阻断术应用于PPP剖宫产术中的手术方式、球囊阻断时机、单次球囊阻断时间等。髂内动脉球囊阻断术在产科临床应用中具有一定效果,但该技术单独应用于穿透性胎盘植入病例时作用有限,其并发症主要包括血栓形成和栓塞、血管损伤、辐射的影响、缺损再灌注损伤等。综述髂内动脉球囊阻断术在PPP剖宫产术中的具体应用和存在的问题,为临床应用提供参考。

Pernicious placenta previa(PPP)is prone to sudden and intractable bleeding.Interventional therapies have been widely used in the treatment of PPP in recent years,to reduce the bleeding during cesarean section and hysterectomy.They mainly include balloon occlusion and arterial embolization.Among them,internal iliac artery balloon occlusion can effectively prevent and reduce the bleeding during cesarean section of PPP,turning emergency into prophylactic treatment.Domestic and foreign research continues to explore the operation method,the timing of balloon occlusion,single balloon occlusion time when internal iliac arteries balloon occlusion is used during cesarean section of PPP.Balloon occlusion of internal iliac arteries has certain effect in clinical application of obstetrics,but the effect is limited when used separately in placenta percreta.Its complications mainly include thrombosis and embolism,vascular injury,radiation effect,and ischemia-reperfusion injury.This article reviews the application and existing problems of internal iliac artery balloon occlusion in cesarean section of PPP,to provide reference for clinical application.