不同手术方式对前置胎盘的疗效比较

Curative effect comparison of different surgical methods on placenta previa

目的比较传统普通剖宫产术、子宫动脉结扎术和Bakri球囊填塞术在前置胎盘患者剖宫产中的疗效。方法选取185例前置胎盘孕产妇,按照手术方式的不同分为子宫动脉结扎组(60例)、Bakri球囊填塞组(61例)和普通剖宫产组(64例)。比较3组患者手术相关指标及并发症发生情况,使用多变量线性回归和Logistic回归分析3种手术方式对孕产妇结局的影响。结果在术中及术后出血量、剖宫产子宫切除术和转入ICU方面,子宫动脉结扎组、Bakri球囊填塞组优于普通剖宫产组,差异有统计学意义(P<0.05)。3组均未出现子宫积脓、粘连或坏死等并发症。多变量线性回归分析显示,子宫动脉结扎技术、手术时间、最后一次剖宫产与目前分娩时间间隔以及Bakri球囊填塞术对术中出血和子宫切除的影响较为显著。Logistic回归分析显示,子宫动脉结扎技术和Bakri球囊填塞术与剖宫产子宫切除的风险显著相关(P<0.05)。结论与传统普通剖宫产手术相比,子宫动脉结扎术和Bakri球囊填塞术具有较高的实用价值,可以有效保留子宫,显著减少术中及术后出血量。

Objective To compare the curative effect of traditional ordinary cesarean section,uterine artery ligation and Bakri balloon tamponade in patients with placenta previa during the cesarean section.Methods A total of 185 pregnant women with placenta previa were selected and divided into the uterine artery ligation group(n=60),the Bakri balloon tamponade group(n=61)and the ordinary cesarean section group(n=64).The operation-related indicators and complications of the three groups were compared,and the Multivariate linear regression and Logistic regression were used to analyze the effects of the three surgical methods on the maternal outcomes.Results In terms of intraoperative and postoperative blood loss,cesarean resection hysterectomy and ICU occupancy rate,the uterine artery ligation group and the Bakri balloon tamponade group were better than the ordinary cesarean section group,and the differences were statistically significant(P<0.05).There was no complication,such as empyema,adhesions or necrosis of uterus,in the three groups.The Multivariate linear regression analysis showed that uterine artery ligation technique,operation time,the interval from the last cesarean section to the current delivery and Bakri balloon tamponade had significant effects on intraoperative bleeding and hysterectomy.The Logistic regression analysis showed that uterine artery ligation technique and Bakri balloon tamponade were significantly associated with the risk of cesarean hysterectomy(P<0.05).Conclusion Compared with the traditional ordinary cesarean section,uterine artery ligation and Bakri balloon tamponade have higher practical value,which can effectively preserve the uterus and significantly reduce intraoperative and postoperative blood loss.