腹主动脉阻断下子宫下段花瓣式缝合成形在凶险性前置胎盘合并胎盘植入术中的效果评价

Evaluation of the effect of petal suture on the lower uterus under abdominal aortic occlusion in pernicious placenta previa with placenta accreta

目的:探讨腹主动脉阻断下子宫下段花瓣式缝合成形应用于凶险性前置胎盘合并胎盘植入手术中的效果及安全性。方法:收集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并分娩的69例凶险性前置胎盘合并胎盘植入的孕妇,行腹主动脉球囊阻断后剖宫产术,术中发现胎盘植入达子宫浆膜层及膀胱后壁者采用子宫下段花瓣式缝合子宫修复成形术治疗,对产妇的结局和预后进行描述性分析。结果:69例凶险性前置胎盘合并胎盘植入的孕妇术中均采用花瓣式缝合成形术,同时部分产妇辅以其他止血措施。69例产妇术中中位出血量为700(425,1500)mL,其中出血量大于1000 mL者36例,出血量最多3700 mL。手术时间45~96(62.7±13.3)min,术后住院时间4~9(6.4±1.7)d。2例术中膀胱破裂,随即行膀胱修补术;1例行子宫次全切术;3例术后出现血栓;1例术后泌尿系感染;1例右侧臀上动脉远端动脉瘤;术后24 h阴道出血量60~420(160.5±97.3)mL,其中3例大于400 mL,经积极处理均好转;术后随访半年无远期并发症。结论:腹主动脉阻断下子宫下段花瓣式缝合成形应用于凶险性前置胎盘合并胎盘植入剖宫产手术中可有效缩短手术时间,减少术中出血,降低切除子宫的风险。

Aim:To explore the effect and safety of the petal suture under abdominal aorta occlusion in the operation of the pernicious placenta previa with placenta accreta.Methods:From January 1,2017 to December 31,2017,69 pregnant women who were diagnosed as placenta previa with placenta accreta in the Third Affiliated Hospital of Zhengzhou University were enrolled in this study,and accepted cesarean following balloon occlusion of abdominal aorta.In the operation,those who were found that the placenta was implanted in the uterine serosa and the posterior wall of the bladder were treated with petal suture on the lower uterus.The outcomes and prognosis of mothers were analyzed by descriptive analysis.Results:All the cases were treated with petal suture during operation,and some pregnant women were supplemented with other hemostatic measures.The intraoperative blood loss of 69 cases was 700(425,1500)mL,among whom,36 cases were more than 1000 mL,and the maximum bleeding volume was 3700 mL.The operation time was 45-96(62.7±13.3)min,and the postoperative hospital stay was 4-9(6.4±1.7)days.Two cases with placenta implanted in bladder received bladder repair,one case had a sub-total hysterectomy,3 cases developed postoperative thrombosis,one patient had urinary tract infection after operation,and one developed aneurysm in right superior gluteal artery.The postoperative 24 hours vaginal bleeding volume was 60-420(160.5±97.3)mL,3 cases were greater than 400 mL,and all of them were improved after treatment.No long-term complication was found during follow-up for six months.Conclusion:Petal suture on the lower uterus under abdominal aorta occlusion in the operation of pernicious placenta previa with placenta accreta can be used to shorten the operation time,reduce intraoperative bleeding and decrease the risk of uterus resection.