腹主动脉球囊阻断术用于凶险性前置胎盘合并胎盘植入剖宫产术的并发症及处理

The complications and management of balloon occlusion of abdominal aorta in cesarean section of pregnant women with pernicious placenta previa with placenta accreta

目的:探讨腹主动脉球囊阻断术应用于凶险性前置胎盘合并胎盘植入的孕妇剖宫产手术中的并发症和处理。方法:回顾分析2017年1月1日至2017年12月31日在郑州大学第三附属医院住院分娩的凶险性前置胎盘伴胎盘植入患者166例,均行腹主动脉球囊阻断下剖宫产术。统计球囊阻断术的手术成功率、手术时间、术中出血量,观察术后球囊置入介入操作相关并发症术后血栓形成、腹股沟穿刺点出血、血肿、大血管损伤、假性动脉瘤等,以及处理措施和结局。患者电话随访至产后6个月。结果:166例患者的腹主动脉球囊阻断成功率为100%,出血量中位数700ml(425~1500ml),其中出血量大于1000ml者74例(44.58%,74/166),出血量最多者3700ml。平均手术时间(65.7±13.3)min,平均术后住院时间(6.6±1.7)天。出现术中及术后介入相关并发症者共7例(4.2%,7/166)术后下肢动脉血栓5例(3%,5/166),术后股浅动脉狭窄1例(0.6%,1/166),右侧臀上动脉远端动脉瘤1例(0.6%,1/166),经积极处理均痊愈。结论:腹主动脉球囊阻断术用于凶险性前置胎盘合并胎盘植入剖宫产术中疗效确切,并发症较低且可有效预防和治疗。

Objective:To investigate the complications and management of balloon occlusion of abdominal aorta in cesarean section of pregnant women with pernicious placenta previa with placenta accreta.Methods:Retrospective analysis of 166 pregnant women who were diagnosed as pernicious placenta previa with placenta accreta in the third Affiliated Hospital of Zhengzhou University from Jan.1,2017 to Dec.31,2017,they were operated cesarean section following balloon occlusion of abdominal aorta.The success rate,operation time,blood loss of the surgery,and the complications associated with balloon occlusion of abdominal aorta:postoperative thrombosis,inguinal puncture bleeding,hematoma,vessel injury,pseudoaneurysm etc,as well as treatment measures and outcomes.The patient was followed up by telephone after discharged to 6 months after delivery.Results:The success rate of balloon occlusion of abdominal aorta in 166 patients was 100%.Blood loss statistics:the median amount of bleeding was 700ml(425~1500ml),of which 74 cases of bleeding more than 1000ml(44.8%,74/166),the maximum amount of bleeding 3700ml.The average operation time was(65.7±13.3)minutes,and the average length postoperative hospital was(6.6±1.7)days.There were 7 cases(4.2%,7/166)operative complications of abdominal aortic ballon occlusion:5 cases developed arterial thrombosis after opertion(3%,5/166),1 case developed superficial femoral artery stenosis(0.6%,1/166),1 case had an aneurysm of right Superior gluteal artery(0.6%,1/166),which were all cured after active treatment.Conclusions:Balloon occlusion of abdominal aorta in cesarean section of pregnant women with pernicious placenta previa with placenta accreta is effective with low complications and preventable and treatable.