球囊阻断双侧髂内动脉治疗凶险型前置胎盘伴胎盘植入的临床应用研究

Clinical application of bilateral internal iliac artery balloon occlusion in treatment of pernicious placenta previa with placenta implantation

目的探讨球囊阻断双侧髂内动脉治疗凶险型前置胎盘伴胎盘植入的临床应用价值。方法回顾性分析哈尔滨医科大学附属第四医院2015年10月~2022年3月间48例凶险型前置胎盘患者(研究组),和同期48例非凶险型前置胎盘患者(对照组)的临床资料。研究组采用球囊阻断双侧髂内动脉治疗;对照组采用传统手术治疗。记录术中产妇出血量、补液量、输血量、尿量、新生儿Apgar评分、新生儿体重、子宫切除率、胎儿受线时间、受线剂量、术后并发症。结果研究组术中出血量(887.63±79.84)mL,输血红细胞(5.73±1.31)U,输入血浆(467.88±89.03)mL,补液量(3417.53±1265.47)mL,尿量(733.88±131.36)mL,1分钟Apgar评分(9.0±0.7)分,5分钟Apgar评分(8.2±1.2)分,10分钟Apgar评分(9.3±0.9)分,放射线时间(40.23±3.41)s,胎儿受线剂量(8.11±1.22)mGy,术后5~7天出院,术后1个月复查子宫及产道复旧正常,术后3~6个月产妇月经恢复正常,新生儿发育无异常;3例患者行子宫切除术,2例患者术后补行双侧子宫动脉栓塞术。对照组术中产妇出血量(1879.35±114.46)mL,输血红细胞(12.13±2.51)U,输入血浆(1364.35±200.21)mL,补液量(8186.32±2361.67)mL,尿量(1506.62±325.31)mL,与研究组比较差异具有统计学意义(P<0.05)。结论球囊阻断双侧髂内动脉能够明显减低子宫动脉血流,减少术中出血,提高产妇生存率,可广泛用于治疗凶险型前置胎盘患者。

Objective To evaluate the clinical application value of bilateral internal iliac artery balloon occlusion in treatment of pernicious placenta previa with placenta implantation.Methods Forty-eight cases of pernicious placenta previa with placenta implantation(study group)and 48 cases of non-pernicious placenta previa during October 2015 to March 2022 in the Fourth Affiliated Hospital of Harbin Medical University were retrospectively analyzed.Intraoperative blood loss,the volume of blood transfusion,infusion quantity,urine volume,neonatal Apgar score,neonatal weight,uterus resection rate,fetal time line,the line dose and the clinical data of postoperative complications were recorded.Results In study group,the intraoperative blood loss was(887.63±79.84)mL,erythrocyte transfusion was(5.73±1.31)U,plasma transfusion was(467.88±89.03)mL,rehydration volume was(3417.53±1265.47)mL,urine volume was(733.88±131.36)mL,Apgar 1 min was(9.0±0.7)scores,Apgar 5 min was(8.2±1.2)scores,Apgar 10 min was(9.3±0.9)scores,fetal exposure time was(40.23±3.41)s,exposure dose was(8.11±1.22)mGy,and 5~7 days after the operation,the uterus and the birth canal returned to normal one month after the operation,3~6 months after the operation,the patient returned to normal menstruation.Neonatal development was normal.Hysterectomy was performed in 3 patients,and bilateral uterine artery embolization was performed in patients.In control group,the intraoperative blood loss was(1879.35±114.46)mL,erythrocyte transfusion was(12.13±2.51)U,plasma transfusion was(1364.35±200.21)mL,rehydration volume(8186.32±2361.67)mL,urine volume was(1506.62±325.31)mL.The differences between two groups were statistically significant(P<0.05).Conclusion Balloon occlusion of bilateral internal iliac artery can significantly reduce uterine artery blood flow,reduce intraoperative bleeding and improve maternal survival rate.It can be widely used to treat patients with pernicious placenta previa.