腹主动脉球囊置入术联合子宫动脉栓塞术治疗凶险性前置胎盘的临床疗效

Clinical efficacy of abdominal aortic balloon implantation combined with uterine artery embolization in the treatment of pernicious placentaprevia

目的探析腹主动脉球囊置入术联合子宫动脉栓塞术治疗凶险性前置胎盘(PPP)的临床疗效。方法回顾性分析2019年1月至2022年1月成都市第五人民医院妇产科92例PPP患者的病例资料,其中42例行剖宫产术后子宫动脉栓塞术,纳入对照组,50例行剖宫产术前腹主动脉球囊置入术联合剖宫产术后子宫动脉栓塞术,纳入观察组。比较两组围手术期参数,新生儿预后,术前、术后1 d血清肌酸激酶、甲胎蛋白水平及并发症。结果观察组手术时间、术中出血量、术中输血量、术后住院时间及子宫切除率、产后出血率均小于对照组(P<0.05);两组新生儿出生后1 min、5 min Apgar评分差异均无统计学意义(P>0.05);两组术后1 d血清肌酸激酶、甲胎蛋白水平均较术前降低(P<0.05),且观察组低于对照组(P<0.05);两组并发症总发生率差异无统计学意义(P>0.05)。结论腹主动脉球囊置入术联合子宫动脉栓塞术治疗PPP可控制出血,降低子宫切除率,且不增加对产妇、新生儿的不良影响。

Objective To explore the clinical efficacy of abdominal aortic balloon implantation combined with uterine artery embolization in the treatment of pernicious placenta previa(PPP).Methods The case data of 92 patients with PPP in Chengdu Fifth People's Hospital between January 2019 and January 2022 were retrospectively analyzed.42 cases underwent uterine artery embolization after cesarean section and were included in the control group,and 50 cases received abdominal aortic balloon implantation before cesarean section combined with uterine artery embolization after cesarean section and were enrolled as the observation group.The perioperative parameters,levels of serum creatine kinase and alphafetoprotein and occurrence of postoperative complications were compared between the two groups.Results The surgical time,intraoperative blood loss,intraoperative blood transfusion volume,postoperative hospital stay,hysterectomy rate and postpartum hemorrhage rate in the observation group were all shorter or less than those in the control group(P<0.05).There were no statistical differences in Apgar scores at 1 min and 5 min after birth between the two groups(P>0.05).The levels of serum creatine kinase and alpha-fetoprotein in the two groups were reduced at 1 d after surgery compared to before surgery(P<0.05),and the levels in the observation group were lower than those in the control group(P<0.05).There was nostatistical significance in the total incidence of postoperative complications between the two groups after surgery(P>0.05).Conclusion Abdominal aortic balloon implantation combined with uterine artery embolization in the treatment of PPP can control the blood loss and reduce the hysterectomy rate,and it will not increase adverse effects on mothers and neonates.