双侧髂内动脉、髂总动脉球囊阻断术辅助凶险性前置胎盘剖宫产临床效果对比

Bilateral internal iliac artery balloon occlusion versus bilateral common iliac artery balloon occlusion in cesarean section for delivery women with pernicious placenta previa: a comparative study

目的比较双侧髂内动脉球囊阻断术和双侧髂总动脉球囊阻断术在凶险性前置胎盘剖宫产术中应用的临床效果。方法回顾性分析2017年9月至2019年2月于徐州医科大学附属医院住院剖宫产分娩的64例凶险性前置胎盘产妇的临床资料。根据剖宫产术前介入术式不同,分为双侧髂内动脉球囊临时阻断术组(A组,n=45)和双侧髂总动脉球临时囊阻断术组(B组,n=19)。观察记录和比较两组剖宫产手术时间、透视时间、术中出血量和输血量、子宫切除率、术后住院时间、新生儿Apgar评分及手术相关并发症。结果两组介入手术均获得成功。A组、B组平均透视时间分别为(194.58±77.41)s、(77.62±51.51)s,术中出血量分别为(1522.22±831.18)mL、(1042.11±478.79)mL,术中输血量分别为(986.67±739.04)mL、(715.79±433.67)mL,差异均有统计学意义(P<0.05);两组剖宫产手术时间、新生儿Apgar评分、术后住院时间、子宫切除率差异均无统计学意义(P>0.05)。结论两种介入球囊阻断术均可有效减少凶险性前置胎盘产妇剖宫产术中出血量,双侧髂总动脉球囊阻断术操作更简单,且剖宫产术中透视时间和出血量更少,临床应用中更具有优势。

Objective To compare the clinical efficacy of bilateral internal iliac artery(IIA)balloon occlusion with that of bilateral common iliac artery(CIA)balloon occlusion in performing cesarean section for delivery women with pernicious placenta previa(PPP).Methods The clinical data of 64 delivery women with PPP,who were admitted to the Affiliated Hospital of Xuzhou Medical University of China during the period from September 2017 to February 2019,were retrospectively analyzed.According to the interventional procedure performed before cesarean section,the patients were divided into bilaterl IIA temporary balloon occlusion group(group A,n=45)and bilaterl CIA temporary balloon occlusion group(group B,n=19).The time spent for cesarean section,the fluoroscopy time,the amount of intraoperative blood loss,the amount of intraoperative blood transfusion,the hysterectomy rate,the postoperative hospitalization days,the neonatal Apgar score,and the procedure-related complications were compared between the two groups.Results Successful interventional procedures were accomplished in all patients of both groups.In group A and group B,the mean fluoroscopy time was(194.58±77.41)seconds and(77.62±51.51)seconds respectively,the mean amount of intraoperative blood loss was(1522.22±831.18)mL and(1042.11±478.79)mL respectively,the mean amount of intraoperative blood transfusion was(986.67±739.04)mL and(715.79±433.67)mL respectively.The differences in the above items between the two groups were statistically significant(P<0.05).No statistically significant differences in the time spent for cesarean section,the neonatal Apgar score,the postoperative hospitalization days and the hysterectomy rate existed between the two groups(P>0.05).Conclusion Both IIA balloon occlusion and CIA balloon occlusion can effectively reduce the amount of blood loss during caesarean section for delivery women with PPP.Bilateral CIA balloon occlusion is easier to operate with less fluoroscopy time and less intraoperative bleeding,therefore,it has more advantages in clinical application.