环子宫下段缝合术治疗凶险性前置胎盘伴胎盘植入性疾病的临床疗效

Clinical efficacy of transverse annular compression suture of lower uterine segment for treatment of pernicious placenta previa complicated with placenta accreta spectrum disorders

目的探讨环子宫下段缝合术治疗凶险性前置胎盘(PPP)伴胎盘植入性疾病(PAS)的临床效果。方法选择2018年1月1日至6月1日,于华中科技大学同济医学院附属湖北妇幼保健院接受剖宫产术分娩,并于术中采用环子宫下段缝合术+常规子宫下段-宫颈缩窄缝合术的5例PPP伴PAS孕产妇为研究对象。回顾性分析这5例患者的一般临床资料,术中出血量、生命体征、血液制品用量,娩出新生儿情况,以及患者术后恢复、随访等情况。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》。结果对本组5例PPP伴PAS患者的研究结果如下:①年龄为28~37岁;均有剖宫产术分娩史,此次妊娠距离上次剖宫产术时间为3~113个月;4例采取择期剖宫产术分娩,1例采取急诊剖宫产术分娩。②剖宫产术均采用腰硬联合麻醉及中心静脉插管,并且均采用腹部直切口;于子宫下段-宫颈胎盘植入部位人工剥离胎盘后,均采用环子宫下段缝合术+Hwu缝合术,其中3例联合使用防波堤缝合术(1例还联合使用Cho缝合术);术中生命体征均平稳,术中出血量为800~1500 mL、输血量为400~800 mL,手术时间为45~96 min,术后均转入重症监护病房(ICU)观察;分娩新生儿情况均良好。③均未发生感染;术后ICU观察4~8 d后,均痊愈出院;出院随访腹部伤口均愈合良好,术后30 d腹部超声检查均显示子宫复旧良好。结论环子宫下段缝合术联合其他子宫下段-宫颈缩窄缝合术,可以有效控制PPP伴PAS孕妇剖宫产术出血,并且预后良好。

Objective To explore the clinical efficacy of transverse annular compression suture of lower uterine segment for treatment of pernicious placenta previa(PPP)complicated with placenta accreta spectrum(PAS)disorders.Methods A total of 5 pregnant women complicated with PPP and PAS disorders who were treated in Maternal and Child Hospital of Hubei Province,Tongji Medical College,Huazhong University of Science and Technology from January 1 to June 1 in 2018 were chosen as research subjects.They all selected cesarean section delivery,and transverse annular compression suture plus other common compression sutures of lower uterine segment for hemostasis after placenta delivered.By retrospective method,general clinical data,volume of intraoperative bleeding,vital signs,volume of transferring blood product,status of newborns,postoperative recovery and follow-up data were analyzed.This study was in line with World Medical Association Declaration of Helsinki revised in 2013.Results The findings of 5 pregnant women complicated with PPP and PAS disorders were as follows.①Their age was 28-37 years old and all had previous cesarean section histories,and this pregnancy was 3-113 months from last cesarean section.4 cases among them took elective cesarean section and 1 case took emergency cesarean section.②Anesthesia for all were epidural combined with spinal anesthesia and placed central venous intubation preventively,cesarean sections used abdominal vertical incision.After manual stripping of placenta from the lower segment of uterine and cervix in which the placenta implanted,suture strategies adopted for all of them were transverse annular compression suture and Hwu suture,suture strategies for 3 cases were also with breakwater-like suture(1 case also combined with Cho suture).They all had stable vital signs,volume of blood bleeding was 800-1500 mL,volume of blood transfusion was 400-800 mL,duration of operation time was 45-96 min.After operation,they were transferred to intensive care unit(ICU).Five of their newborns had good conditions after birth.③No infection was observed after operation and duration of stay in ICU was 4-8 d,then healed and discharged from hospital.During follow-up period,their abdominal incisions healed well,and abdominal ultrasound examination result showed their uterus recovered well after 30 d of cesarean section.Conclusions Suture strategies of transverse annular compression suture plus others compression sutures of lower uterine segment were effective hemostasis for cesarean section of pregnant women complicated with PPP and PAS disorders,and their prognosis were good.