凶险性前置胎盘伴重型胎盘植入术中不同膀胱分离时机的临床应用价值

Clinical Value of Different Bladder Separation Time in the Operation of Pernicious Placenta Previa with Severe Placenta Accreta

目的:探讨凶险性前置胎盘伴重型胎盘植入患者术中不同膀胱分离时机的临床应用价值。方法:选择2017年1月至2020年12月于甘肃省妇幼保健院行术前胎盘检查,超声评分诊断为凶险性前置胎盘伴重型(植入型和穿透型)胎盘植入并在术中确诊的204例孕妇作为研究对象,根据术中膀胱分离时机分为胎儿娩出前下推膀胱81例(娩出前下推组)及胎儿娩出后下推膀胱123例(娩出后下推组),比较两组孕妇的术中情况、术后并发症及围产儿结局。结果:①娩出前下推组与娩出后下推组比较,手术时间较短(103.16±49.00 min vs 148.45±67.60 min)、术中出血量较少(1000 ml vs 2000 ml)、输血量较少(400 ml vs 1150 ml),差异均有统计学意义(P<0.05);②两组的子宫切除率及术中凝血功能异常的发生率比较,差异无统计学意义(P>0.05);娩出前下推组膀胱破裂率(2.47%)低于娩出后下推组(12.20%),差异有统计学意义(P<0.05);③两组的平均住院时间、术后发热、术后24小时出血、新生儿结局比较,差异均无统计学意义(P>0.05)。结论:在凶险性前置胎盘伴重型胎盘植入患者术中,胎儿娩出前下推膀胱可明显减少术中出血量、术中输血量,降低膀胱破裂的发生率,可供临床推广应用。

Objective:To explore the clinical value of different bladder separation times in patients with pernicious placenta previa with severe placenta accreta.Methods:From January 2017 to December 2020,204 cases diagnosed as pernicious placenta previa with severe placenta accreta(placenta increta and placenta percreta)by prenatal ultrasonic score system and confirmed by intraoperative findings at the Gansu Provincial Maternity and Child Care Hospital were enrolled in this study.According to the timing of bladder separation during operation,they were divided into 81 cases of bladder pushdown before fetal delivery(pushdown bladder before fetal delivery group)and 123 cases of bladder pushdown after fetal delivery(pushdown bladder after fetal delivery group).The intraoperative conditions,postoperative complications and perinatal outcomes of the two groups were compared.Results:①Compared with pushdown bladder after fetal delivery group,the pushdown bladder before fetal delivery group had shorter operation time(103.16±49.00 min vs.148.45±67.60 min),less intraoperative bleeding(1000 ml vs.2000 ml),and less blood transfusion(400 ml vs.1150 ml).The difference between the two groups was statistically significant(P<0.05).②There was no significant difference in the rate of hysterectomy and the incidence of abnormal coagulation function between the two groups(P>0.05);The bladder rupture rate in the group before fetal delivery(2.47%)was lower than that in the group after fetal delivery(12.20%)(P<0.05).③There was no significant difference in the average length of hospital stay,postoperative fever,24-hour postoperative bleeding and neonatal outcomes between the two groups(P>0.05).Conclusions:In the operation of Pernicious placenta previa with severe placenta accreta,pushdown the bladder before fetal delivery can significantly reduce the amount of intraoperative bleeding and intraoperative blood transfusion,and reduce the incidence of bladder rupture,which can be popularized and applied in clinic.