腹主动脉球囊预置术联合宫颈多重缝扎术预防凶险性前置胎盘产科大出血的研究

Prevention of Severe Obstetric Hemorrhage of Pemicious Placenta Previa by Balloon Occlusion of Abdominal Aorta Combined with Multiple Cervical Cerclage

目的:探讨腹主动脉球囊预置术联合宫颈多重缝扎术预防凶险性前置胎盘产科大出血的效果。方法:选取本院2018年1月-2019年3月凶险性前置胎盘患者83例作为研究对象,采用随机数字表法分为腹主动脉组(n=41)与髂内动脉组(n=42)。腹主动脉组采用腹主动脉球囊预置术,髂内动脉采用髂内动脉球囊预置术,两组剖宫产术后均行宫颈多重缝扎术。比较两组手术相关指标、并发症发生情况、子宫切除率及安全性指标。结果:腹主动脉组球囊预置术时间短于髂内动脉组,且术中失血量明显少于髂内动脉组(P<0.05)。两组动脉阻滞时间、术后24 h失血量与剖宫产手术时间比较,差异均无统计学意义(P>0.05)。两组子宫切除率比较,差异无统计学意义(P>0.05)。两组均无并发症发生。腹主动脉组产妇与胎儿透视时间均短于髂内动脉组,且腹主动脉组产妇与胎儿辐射剂量均低于髂内动脉组(P<0.05)。结论:腹主动脉球囊预置术联合宫颈多重缝扎术可更好地预防凶险性前置胎盘产科大出血,减少术中出血量,缩短球囊预置术与产妇和胎儿透视时间,降低产妇和胎儿辐射剂量,值得临床推广应用。

Objective: To investigate the effect of balloon occlusion of abdominal aorta combined with multiple cervical cerclage for the prevention of severe obstetric hemorrhage of pemicious placenta previa. Method: A total of 83 patients with pemicious placenta previa from January 2018 to March 2019 in our hospital were selected as the study objects. They were divided into abdominal aorta group(n=41) and internal iliac artery group(n=42) according to the random number table method. The abdominal aorta group was treated with balloon occlusion of abdominal aorta, and the internal iliac artery was treated with balloon occlusion of internal iliac artery. After cesarean section, both groups were treated with multiple cervical cerclage. The operation related indexes, complications, hysterectomy rate and safety indexes were compared between the two groups. Result: The time of balloon occlusion in the abdominal aorta group was lower than that in the internal iliac artery group, and the intraoperative blood loss was significantly lower than that in the internal iliac artery group(P<0.05). There were no statistically significant differences between the two groups in the time of artery block, blood loss at 24 h after operation and the time of cesarean section(P>0.05). There was no significant difference in uterine resection rate between the two groups(P>0.05). No complications occurred in both groups. The fluoroscopy time of parturients and fetuses in the abdominal aorta group were lower than those in the internal iliac artery group, and the radiation dose of parturients and fetuses in the abdominal aorta group were lower than those in the internal iliac artery group(P<0.05). Conclusion: Balloon occlusion of abdominal aorta combined with multiple cervical cerclage can better prevent severe obstetric hemorrhage of pemicious placenta previa. It can reduce intraoperative blood loss, shorten balloon occlusion time and fluoroscopy time of parturients and fetuses, and reduce the radiation dose of parturients and fetuses, which is worthy of clinical application.