地毯式膀胱分离术在穿透性胎盘植入侵犯膀胱手术中的应用

The effect of carpet bladder separation in the surgery of penetrating placental implantation invasiving bladder

目的评价地毯式膀胱分离术在穿透性胎盘植入侵犯膀胱手术中的应用价值。方法选择2016年1月至2020年12月于甘肃省妇幼保健院分娩,根据术前检查、术中临床诊断确诊的穿透性胎盘植入侵犯膀胱者52例,手术中采取地毯式膀胱分离术者为研究组(35例),采取传统钝性下推分离膀胱术者为对照组(17例)。收集并比较两组孕妇的一般情况、术中及术后并发症发生情况。结果两组孕妇的年龄、既往人工流产次数、距末次妊娠间隔时间、孕次、产次、既往剖宫产次数,以及终止妊娠孕周比较,差异均无统计学意义(P>0.05)。研究组的术中出血、输红细胞量、子宫切除率、膀胱损伤率均低于对照组,差异有统计学意义(P<0.05),两组手术时间、术后24 h出血量、住院时间比较,差异无统计学意义(P>0.05)。结论地毯式膀胱分离术在穿透性胎盘植入侵犯膀胱手术中,可有效控制术中出血量,降低术中并发症的发生率,是一种可行、安全、有效的膀胱分离技术。

Objective To evaluate the application value of carpet bladder separation in the surgery of penetrating placenta implantation invasiving bladder.Methods sFrom January 2016 to December 2020,52 cases of penetrating placenta implantation invading the bladder delivered in Gansu Maternal and Child Health Hospital were selected,35 cases of patients treated with carpet bladder separation were set as study group,and the other 17 cases treated with conventional blunt downpush bladder separation were set as control group.The genera situation,intraoperative and postoperative complication of pregnant women were collected and analyzed.Results There was no significant dfference between the two groups in terms of age,number of previous induced abortions,time interval from the last pregnancy,number of pregnancies,delivery times,previous cesarean section times,and gestational weeks of termination of pregnancy(P>0.05).The intraoperative bleeding,the amount of red blood cells transfused,the rate of hysterectomy,and the rate of bladder injury in the study group were lower than those in the control group,with statistically significant differences(P<0.05).There was no significant difference between the two groups in terms of operation time,blood loss in 24 hours after operation and hospital stay(P>0.05).Conclusions In penetrating placenta implantation invasiving bladder,carpet bladder separation could effectively reduce intraoperative hemorrhage and the occurrence of operative complication,which is a feasible,safe,effective method for bladder separation.