超声引导腹主动脉球囊阻断在胎盘植入中的临床应用研究

Clinical application of ultrasound-guided balloon block of abdominal aorta in placenta implantation

目的:探讨超声评分量表诊断为胎盘植入(PA)患者行超声引导下腹主动脉球囊阻断(AABO)的临床效果及安全性,为临床治疗PA提供完整的诊断及治疗方案。方法:回顾性分析在我院行术中超声引导下AABO并且术后证实为PA的19例患者资料,19例中植入型胎盘15例,穿透型胎盘4例。记录剖腹产产时失血量、子宫切除及其他相关指标。结果:19例患者球囊放置成功率100%,产妇产时失血量820(620,1600)mL,平均(1216.3±769.2)mL,1例孕妇出血量高达3100 mL。子宫切除率26.3%(5/19),未切除子宫的14例患者,6例在胎盘娩出后松开腹主动脉球囊,宫颈内口处仍有活动性出血,其中2例患者首先给予子宫动脉结扎术但止血效果不佳,紧急更换子宫动脉栓塞术并成功止血,另4例仅行双侧子宫动脉结扎术便成功控制出血。结论:PA超声评分量表分析结果≥5分时选用超声引导球囊介入术,不仅有减少产妇分娩期间失血量的疗效,还能降低生殖器官的切除率,产妇及胎儿的安全也能得到一定的保障。但子宫切除与否,与胎盘植入子宫肌层的深度以及侵入的范围相关性更大。

Objective:To investigate the clinical effect and safety of ultrasound-guided balloon block of lower abdominal aorta in patients diagnosed with placenta implantation by ultrasound scoring scale,and to provide a complete diagnosis and treatment plan for clinical treatment of PA.Methods:Retrospective analysis was made of the data of 19 patients who underwent ultrasound-guided balloon occution of lower abdominal aorta in our hospital and were confirmed to be placenta implantation after surgery,including 15 cases of implanted placenta and 4 cases of penetrating placenta.Blood loss during cesarean section,hysterectomy and other related indexes were recorded.Results:The success rate of balloon placement was 100%in 19 patients.The maternal blood loss at delivery was 820(620,1600)mL,with an average of(1216.3±769.2)mL.The bleeding volume of one pregnant woman was as high as 3100 mL.Uterus resection rate 26.3%(5/19),no uterus resection in the 14 patients.6 cases after open aortic balloon,intracervical mouth still have active bleeding.2 cases of these patients were first given uterine artery ligation and hemostatic effect was not good,urgent replacement of uterine artery embolization and managed to stop bleeding,the other 4 cases with ligation of bilateral uterine artery ligation were successful to control bleeding.Conclusion:The ultrasound-guided balloon occlusion of the lower abdominal aorta can effectively reduce the intraoperative blood loss and hysterectomy rate when the ultrasound-guided ultrasonographic scoring scale diagnostic results of placenta implantation are≥5 points,and protect the life of mother and child from being threatened.However,whether the uterus is removed or not is more related to the depth of placenta implantation into the myometrium and the extent of invasion.