Subsequent pregnancy outcomes and fertility rates in the case series that underwent bilateral hypogastric artery ligation(BHGAL)due to severe postpartum hemorrhage

Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study.The records of cases were obtained from the hospital database,retrospectively.Maternal demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were recorded.In cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation.Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.Results:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the surgery.Six of these cases(23%)were diagnosed with secondary infertility.The fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three abortions.Conclusions:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy outcomes.This is a tertiary center experience and cohort studies with large patient series are needed.

Emergency internal iliac artery temporary occlusion after massive hemorrhage during surgery of cesarean scar pregnancy:A case report

BACKGROUND Cesarean scar pregnancy(CSP)is rare but may result in uterine rupture during pregnancy or massive hemorrhage during abortion procedures.Awareness of this condition is increasing,and most patients with CSP are now diagnosed early and can be managed safely.However,some atypical patients are misdiagnosed,and their surgical risks are underestimated,increasing the risk of fatal hemorrhage.CASE SUMMARY A 27-year-old Asian woman visited our institution because of abnormal pregnancy,and she was diagnosed with a hydatidiform mole through transvaginal ultrasound(TVS).Under hysteroscopy,a large amount of placental tissue was found in the scar of the lower uterine segment,and a sudden massive hemorrhage occurred during the removal process.The bilateral internal iliac arteries were temporarily blocked under laparoscopy,and scar resection and repair were rapidly performed.She was discharged in good condition 5 d after the operation.CONCLUSION Although TVS is widely used in the diagnosis of CSP,delays in the diagnosis of atypical CSP remain.Surgical treatment following internal iliac artery temporary occlusion may be an appropriate management method for unanticipated massive hemorrhage during CSP surgery.

Role of Anterior Division of Internal Iliac Artery Ligation in Refractory Postpartum Haemorrhage—A Tertiary Care Hospital Based Study

Objective: Postpartum haemorrhage (PPH) is one of the important obstetrical emergencies and a leading cause of maternal morbidity and mortality. According to the World Health Organization, postpartum haemorrhage constitutes 25% of all maternal deaths worldwide. In situations where medical line of management fails to control postpartum haemorrhage, anterior division of internal iliac artery ligation can play an important role as a lifesaving and fertility preserving surgical procedure. Keeping this in mind, our study aimed to analyze indications and efficacy of anterior division of Internal Iliac artery ligation in the form of uterine salvage and saving maternal life. Study design: This was a retrospective study carried out in the Department of Obstetrics and Gynaecology, Government Medical College, Aurangabad during the period of July 2014-January 2016. A total of 57 cases that had undergone ligation of anterior division of internal iliac artery were included in the study and different indications and efficacy were studied. Results: Atonic PPH (52.63%) leads the list of indications for ligation anterior division of internal iliac artery ligation followed by traumatic (19.29%), adherent placenta (12.2%), mixed variety (10.52%) and coagulopathy (5.26). Maximum efficacy in terms of preserving fertility and saving maternal life was 73.33% and 93.3% respectively in atonic PPH. Overall efficacy of this procedure in terms of uterine salvage was 54.38% and in terms of saving maternal life was 87.71%. Conclusion: Anterior division of IIAL was effective method in controlling refractory PPH, reducing morbidity and preserving uterus and future fertility. It is safe life saving procedure at experienced hands.

Effects of internal iliac artery embolization on systemic inflammatory response syndrome in dogs with simulatedpelvic-fracture combined with massive bleeding

Background: Pelvic fracture combined with massive bleeding(PFCMB) is a complex issue in clinical practice. Currently, the use of angiography and embolization for the treatment of PFCMB obtains good results. The aim of this study is to observe the effects of early internal iliac artery embolization on the systemic inflammatory response syndrome(SIRS) in dogs with simulated-pelvic-fracture combined with massive bleeding.Methods: Twenty adult dogs were randomly divided into an embolization group(EG) and a control group(CG). For the two groups, heart rate, respiratory rate and body temperature and other physiological variables were measured, and IL-6, TNF-α and arterial blood gas levels were monitored. These variables were assayed every 30 min until death in the CG, while dogs in the EG underwent arterial angiography after 60 min of modeling. The internal iliac artery was embolized on the injured side.Results: The average time to SIRS in the CG was 3.56 h, occurring at a rate of 90%(9/10) within 24 h, with a mortality rate of 50%(5/10); the average time to SIRS for the EG was 5.33 h, occurring at a rate of 30%(3/10) within 24 h, with a mortality rate of 10%(1/10). When SIRS occurred in the EG, the mean plasma IL-6 level was 52.66±7.38pg/ml and the TNF-ps, tα level was 11.45±2.72ng/ml, showing a significant difference with those of the CG(P<0.05). In the two grouhe respiratory rate and leukocyte levels were higher at each monitored time after modeling than those before modeling; the mean arterial pressure, levels of hemoglobin and oxygen partial pressure were significantly lower at each time point after modeling than those before modeling except for the mean arterial pressure at 0h in EG; the platelet levels at 4 and 8h were higher than those before modeling; and the differences were statistically significant(P<0.05). In the EG, the mean arterial pressure, heart rate, respiratory rate and hemoglobin levels at 2, 4 and 8h were lower than those at 0h; the levels of leukocytes, platelets and carbon dioxide partial pressure at 4 and 8h after modeling were higher than those at 0h, and the differences were statistically significant(P<0.05, P<0.01); in the CG after modeling, the mean arterial pressure, levels of hemoglobin and carbon dioxide partial pressure at 2, 4 and 8h were lower than those at 0h; the levels of heart rate and leukocytes were higher than those before modeling; the respiratory rate and platelet levels at 4 and 8h were higher than those at 0h; and the differences were statistically significant(P<0.05). The levels of the mean arterial pressure and hemoglobin at 4 and 8h and the p H values at 8h after modeling in the EG were significantly higher than those in the CG, while the heart rate and respiratory rate at 4 and 8h were significantly lower than those in the CG. The p H values at 8h after modeling were significantly lower than those of the other monitored times in the CG(P<0.05, P<0.01). The two groups had elevated levels of alkaline phosphatase after injury induction.Conclusion: Through the use of an on-spot interventional treatment cabin, early internal iliac artery embolization can control bleeding associated with pelvic fractures, delay the occurrence of SIRS, and improve the success rate of the treatment of pelvic fracture combined with bleeding.

Selective Internal Iliac Artery Oxaliplatin Infusion： Another Facultative Treatment to Unremitting Hematuria in Stage T4 Bladder Carcinoma

OBJECTIVE To observe and evaluate the value of utilizing selective internal iliac artery infusion and selective internal iliac artery embolization for the treatment of unremitting gross hematuria of stage T4 bladder carcinoma. METHODS Fifty-eight stage T4 bladder carcinoma patients were selected. The patients were grouped to the TAI group and the TAE group. The main symptom of hemorrhage was gross hematuria. None of the patients in our study could receive trunk embolization. The infusion plan was oxaliplatin （100 mg/m2） and epirubicin （EPI 50mg/m2）. Embolization was done with coils or strips of gelatin sponge. The duration of gross hematuria was observed. Routine urinalysis and routine blood examination were performed. EORTC QLQ-C30 was used to evaluate the quality of life before and after treatment. RESULTS Gross hematuria and hematuria by light microscope in all patients were reviewed. Resolution time of gross hematuria in the TAI group was 6.7 ± 1.8 days and that in the TAE group was 3.5 ± 0.7 days. The changes in routine urianlysis, routine blood examination and EORTC QLQ-C30 are shown in Figs.l-3. Gross hematuria disappeared in both groups within 7 days after treatment, but the time for the gross hematuria to resolve in the TAE group was much less than that in TAI group （t = 2.51, P 〈 0.01）, and there were no significant differences in the 7th and 21st day between the 2 groups. On the 90th day, the number of erythrocytes in the urine was near 30, close to gross hematuria. The EORTC QLQ-C30 scores decreased after interventional therapy in both groups, which means that quality of life was increased, but there were no significant differences between the 2 groups. CONCLUSION Selective internal iliac artery infusion and selective internal iliac artery embolization are safe, and, in our study, therapeutic efficacy was satisfactory in treating unremitting gross hematuria of stage T4 bladder carcinoma in patients who could not receive trunk embolization. TAE can stop gross hematuria in the short term, but it can be used just once and the long-term therapeutic effect is not satisfactory. TAI had a therapeutic effect similar to TAE, but for a shorter duration, and TAI can be performed multiple times. TAI is one of the facultative treatments for treating gross hematuria of stage T4 bladder carcinoma.

Placenta previa and percreta with massive genital bleeding in the first trimester of pregnancy: A case report

A 40-year-old woman with a history of cesarean section and 3 episodes of uterine curettage for spontaneous or induced abortion presented with massive genital hemorrhage in the ninth week of gestation;she was treated with red cell concentrate and fresh frozen plasma transfusion. She was admitted to our hospital at the 11th week of gestation for continuous genital hemorrhage and cervical shortening (20 mm). Ultrasonography revealed placenta previa totalis. A lowlying gestational sac in early pregnancy, vascular lacunae, and an obscured retroplacental sonolucent zone indicated placenta percreta;magnetic resonance imaging showed similar findings. Owing to placenta percreta, uterus preservation was considered impossible. Elective cesarean section followed by total hysterectomy was performed at the 37th week of gestation, with bilateral internal iliac artery balloon catheter occlusion for reducing blood loss. The perioperative blood loss was 2,835 mL, for which the patient received blood transfusion. The postoperative course was uncomplicated.

子宫血管缝扎术及宫颈环状缝扎术联合双侧髂内动脉球囊阻断治疗PPP合并胎盘植入效果

目的:探讨凶险性前置胎盘(PPP)合并胎盘植入治疗效果。方法:选取2019年3月-2023年5月本院就诊治疗的PPP合并胎盘植入患者56例临床资料,根据治疗方式不同分为两组,采用子宫血管缝扎术及宫颈环状缝扎术联合双侧髂内动脉球囊阻断治疗为观察组26例,采用单纯双侧髂内动脉球囊阻断治疗为对照组30例,分析两组相关指标。结果:治疗后两组甲胎蛋白及绒毛膜促性腺激素水平均较术前降低,且观察组(82.6±26.3 ng/ml、122.3±56.3 mIU/ml)低于对照组(113.0±41.1 ng/ml、649.5±86.5 mIU/ml),总并发症发生率观察组(3.8%)低于对照组(23.3%)(均P<0.05);两组新生儿Apgar评分(9.6±0.3分、9.3±0.6分)无差异(P>0.05)。观察组住院时间(6.6±1.2d)及住院费用(3.2±0.6)万元均低于对照组(7.9±1.5d)(4.3±1.0)万元(P<0.05)结论:采取子宫血管缝扎与宫颈环状缝扎术、双侧髂内动脉球囊阻断治疗PPP合并胎盘植入可效果更佳,且可降低术后并发症,术后恢复更快,对新生儿未产生不良影响。

1例凶险性前置胎盘行双侧骼内动脉球囊封堵联合剖宫产术后并发DIC的护理

总结1例凶险性前置胎盘行双侧骼内动脉球囊封堵联合剖宫产术后并发弥散性血管内凝血(DIC)的护理。通过多学科团队的联合诊治及护理,病人病情平稳出院。随访半年,病人状况良好。

弹簧圈在腹主动脉瘤腔内修复术髂内动脉处理中应用的临床效果分析

目的:对行腹主动脉瘤腔内修复术(EVAR)的患者进行随访和临床资料分析,提高对术后并发症的认识,以指导临床工作。方法:回顾性分析大理大学第一附属医院2012年1月至2021年12月收治的96例行EVAR患者的临床资料,按是否进行髂内动脉弹簧圈栓塞将患者分为实验组和对照组,观察并比较2组患者盆腔缺血相关并发症(臀肌萎缩、跛行、性功能障碍等)的发生情况。结果:实验组中有6例(18.2%)患者发生跛行,4例(12.1%)患者发生臀肌萎缩,对照组中各有1例(1.6%)患者发生跛行和臀肌萎缩,实验组患者术后盆腔缺血相关并发症的总发生率显著高于对照组,差异有统计学意义(P<0.05)。实验组无患者发生Ⅱ型内漏,对照组中有2例(3.2%)患者发生Ⅱ型内漏。结论:髂内动脉弹簧圈栓塞能在一定程度上预防EVAR术后Ⅱ型内漏的发生,但需权衡其可能引发的盆腔缺血相关并发症,在行EVAR时应尽量保证髂内动脉的通畅和盆腔循环的畅通,以最大程度减少术后相关并发症的发生。

腹主动脉预置球囊辅助凶险性前置胎盘伴胎盘植入剖宫产的临床应用研究

目的探讨腹主动脉预置球囊术对凶险性前置胎盘(PPP)伴胎盘植入剖宫产产妇应激反应、凝血功能及母婴结局的影响。方法选取2021年1月至2023年6月三门峡市中心医院收治的62例PPP伴胎盘植入产妇,按照随机数表法分为观察组和对照组各31例。两组产妇均行剖宫产术,对照组行髂内动脉预置球囊术,研究组行腹主动脉预置球囊术。比较两组产妇的手术指标、手术前后的应激反应指标[肾上腺素(E)、促肾上腺皮质激素(ACTH)、皮质醇(Cor)、去甲肾上腺素(NE)]、凝血功能[凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]、血红蛋白(Hb)、红细胞压积(HCT)水平,同时比较两组新生儿的相关情况及产妇的子宫切除率和并发症发生率。结果研究组产妇的手术时间、透视耗时、住院时间分别为(111.63±15.59)min、(15.67±3.27)s、(6.04±0.53)d,明显短于对照组的(128.75±20.03)min、(28.96±5.11)s、(6.65±0.74)d,放射剂量、术中与术后24 h出血量、术中输血量分别为(4.21±0.74)mGy、(752.31±153.66)mL、(135.47±20.37)mL、(357.92±32.40)mL,明显少于对照组的(15.63±2.39)mGy、(1026.47±212.52)mL、(328.19±38.92)mL、(950.30±85.61)mL,差异均有统计学意义(P<0.05);术后24 h,研究组产妇的血清Cor、ACTH、E、NE水平明显低于对照组,APTT、TT、PT、FIB、Hb、HCT明显高于对照组,差异均有统计学意义(P<0.05);出生1 min、5 min,研究组新生儿Apgar评分分别为(9.02±0.27)分、(9.52±0.24)分,明显高于对照组的(8.74±0.33)分、(9.13±0.30)分,新生儿窒息率为0,明显低于对照组的19.35%,差异均有统计学意义(P<0.05);研究组产妇的子宫切除率、并发症发生率分别为6.45%、6.45%,明显低于对照组的29.03%、32.26%,差异均有统计学意义(P<0.05)。结论腹主动脉预置球囊可减少PPP伴胎盘植入剖宫术中放射剂量、出血量及输血量,减少应激反应,改善凝血功能,促进术后早期恢复,同时提高手术安全性,改善新生儿分娩结局,降低窒息与子宫切除风险。

髂内动脉球囊预置阻断术在植入型凶险性前置胎盘中的临床研究

目的:探讨髂内动脉球囊预置阻断术在植入型凶险性前置胎盘中的临床价值。方法:选取2021年7月—2024年1月阳江市人民医院收治的60例植入型凶险性前置胎盘患者。根据随机数表法将其分为对照组与观察组,各30例。两组均行剖宫产,对照组应用常规止血措施,观察组应用双侧髂内动脉球囊预置术。比较两组围手术期指标、新生儿情况、子宫切除率、并发症。结果:观察组术中出血量少于对照组,手术时间与住院时间均短于对照组,差异有统计学意义(P<0.05)。两组新生儿出生1 min、5 min、10 min Apgar评分比较,差异无统计学意义(P>0.05)。观察组子宫切除率、并发症发生率均低于对照组,差异有统计学意义(P<0.05)。结论:双侧髂内动脉球囊预置术应用于植入型凶险性前置胎盘患者中效果显著,能够减少产妇术中出血量,降低大出血风险,缩短手术时间和住院时间,降低患者子宫切除率与术后并发症发生率。

Vascular complications following prophylactic balloon occlusion of the internal iliac arteries resolved by successful interventional thrombolysis in a patient with morbidly adherent placenta

The increasing incidence of morbidly adherent placenta （MAP） is placing women at a higher risk of life-threatening massive hemorrhage. The involvement of interventional radiology to manage this complex condition by performing prophylactic lilac artery balloon occlusion has been reported recently. However, the effectiveness and safety of this technique have not been fully determined. Here we report the case of a 25-year-old woman with placenta increta with preemptive bilateral internal lilac artery balloons who had external lilac artery thrombosis detected by computed tomography angiography （CTA） 72 h post cesarean section. A digital subtraction angiogram （DSA） and intra-arterial thrombolysis were instantly performed followed by supplementary conservative treatments, leading to a desirable resolution, of thrombus without sequela. This is the first report of vascular complications with successful interventional thrombolysis in this setting. Our experience suggests that prophylactic lilac artery balloon occlusion should be used cautiously in cases of MAP and consideration given to minimizing vascular complications given the hypercoagulable state of pregnancy.

Using a Surgeon-modified Iliac Branch Device to Preserve the Internal Iliac Artery during Endovascular Aneurysm Repair： Single-center Experiences and Early Results

Background：To evaluate the feasibility of a new surgeon-modified iliac branch device （IBD） technique to maintain pelvic perfusion in the management of common iliac artery （CIA） aneurysm during endovascular aneurysm repair （EVAR）.Methods：From January 2011 to December 2013,a new surgeon-modified IBD technique was performed in department of vascular surgery of Peking Union Medical College Hospital in five patients treated for CIA aneurysm with or without abdominal aortic aneurysm.A stent-graft limb was initially deployed in vitro,anastomosed with vascular graft,creating a modified IBD reloaded into a larger sheath,with or without a guidewire preloaded into the side branch.The reloaded IBD was then placed in the iliac artery,with a covered stent bridging internal iliac artery and the branch.Finally,a bifurcated stent-graft was deployed,and a limb device was used to connect the main body and IBD.Results：Technical successes were obtained in all patients.The mean follow-up length was 24 months （range：6-38 months）.All grafts remained patent without any sign of endoleaks.There were no aneurysm ruptures,deaths,or other complications related to pelvic flow.Conclusions：Using the surgeon-modified IBD to preserve pelvic flow is a feasible endovascular technique and an appealing solution for personalized treatment of CIA aneurysm during EVAR.

Internal iliac artery ligation as a damage control method in hemodynamically unstable pelvic fractures:A systematic review of the literature

Purpose:Internal iliac artery ligation(IIAL)has been used as a damage control procedure to treat hemodynamically unstable pelvic fracture for many years.However,there is ongoing debate regarding the effectiveness and safety of this hemostatic method.Therefore,we performed a systematic literature review to assess the efficacy and safety of IIAL for pelvic fracture hemostasis.Methods:Three major databases,PubMed,Embase,and Google Scholar,were searched to screen eligible original studies published in English journals.Two reviewers independently read the titles,abstracts,and full texts of all literature.Articles were included if they reported the use and effects of IIAL.Results:A total of 171 articles were initially identified,with 22 fully meeting the inclusion criteria.Among the analyzed cases,up to 66.7%of patients had associated abdominal and pelvic organ injuries,with the urethra being the most frequently injured organ,followed by the bowel.The outcomes of IIAL for achieving hemostasis in pelvic fractures were found to be satisfactory,with an effective rate of 80%.Hemorrhagic shock was the leading cause of death,followed by craniocerebral injury.Notably,no reports of ischemic complications involving the pelvic organs due to IIAL were found.Conclusion:IIAL has a good effect in treating hemodynamically unstable pelvic fracture without the risk of pelvic organ ischemia.This procedure should be considered a priority for hemodynamically unstable pelvic fracture patients with abdominal organ injuries.

介入法构建新西兰兔髂内动脉出血模型

目的 应用介入法构建新西兰兔髂内动脉出血模型。方法 随机挑选8只新西兰雌兔,全身麻醉后,抽全血检测红细胞计数、血红蛋白及红细胞压积含量;经皮切开暴露颈动脉,21G微穿针穿刺左颈总动脉,置入V18导丝交换微导管,行全主动脉血管造影,于腹主动脉下段造影明确左髂内动脉开口,超选左侧髂内动脉主干,予V18导丝硬端将左髂内动脉戳破,造影见左髂内动脉造影剂溢出,评估造模成功,10 min后微导管分别超选双侧髂内动脉,予自制明胶海绵条栓塞双侧髂内动脉主干,复查造影栓塞满意,拔除微导管,明胶海绵块压迫左颈动脉15 min,观察无出血,缝合皮肤,复查全血红细胞、血红蛋白及红细胞压积含量。结果 8只新西兰兔造影见全身动脉走形与人相似;8只新西兰兔造模均成功,造影见髂内动脉造影剂明显溢出,造模后的全血红细胞计数3.6×10^(12)/L,血红蛋白含量75 g/L,红细胞压积25%,明显低于造模前的全血红细胞计数(4.4×10^(12)/L),血红蛋白含量(93 g/L)和红细胞压积(32%),差异均有显著统计学意义(P<0.01);8只新西兰兔栓塞后麻醉复苏均存活,无感染、脑梗死等并发症。结论 经介入血管腔内导丝锐性戳破法可成功构建兔髂内动脉出血模型,该法具有精准、微创、简单,易复制等优点,可用于盆腔脏器出血的基础研究。

回收式自体输血联合双侧髂内动脉预置术对出血高危患者在剖宫产术中的应用

目的探讨回收式自体输血联合双侧髂内动脉球囊预置术对出血高危患者在剖宫产术中的应用效果。方法前瞻性选取本院2021年1月—2023年5月的162名进行剖宫产的出血高危患者,根据输血方式适应证不同分为A、B、C 3组,每组各54例。A组采用异体血输入,B组采用自体血输入,C组采用自体输血联合双侧髂内动脉球囊预置术。结果术中出血量(1600 mL vs 1500 mL vs 800 mL)、术后住院时间(7 d vs 7 d vs 6 d)和手术时间(107 min vs 104.50 min vs 77 min)C组均低于A、B 2组(P<0.05),A、B 2组比较无差异(P>0.05);C组输入自体血量低于B组(525.5 mL vs 261 mL,P<0.05)。C组异体红细胞的输入占比低于A组(22.22%vs 100.00%,P<0.0167);C组血浆的输入占比低于A、B 2组(18.50%vs 66.70%/18.50%vs 44.40%,P<0.0167);C组凝血功能障碍发生率低于A组(7.41%vs 25.93%,P<0.0167);C组子宫切除发生率低于A组(1.85%vs 16.67%,P<0.0167),A、B 2组比较无差异(16.67%vs 11.11%,P>0.0167)。结论在出血高危患者剖宫产术中采用回收式自体输血联合双侧髂内动脉球囊预置术效果理想,能明显减少术中失血量、术中自体血回输量、异体红细胞和血浆成分的输入量,同时减少手术时间和术后住院时间。此外,还改善凝血功能和子宫切除情况,有利于保障产妇的生命安全和促进早期康复,且一定程度保留患者生育能力,值得临床进一步推广。

髂内动脉栓塞术联合剖宫产术对凶险性前置胎盘并大出血产妇围手术期指标及术后并发症的影响

目的探讨髂内动脉栓塞术联合剖宫产术对凶险性前置胎盘并大出血产妇围手术期指标及术后并发症的影响。方法回顾性选取2019年1月至2021年1月收治的凶险性前置胎盘并大出血患者44例作研究对象,按治疗方式分为传统手术组21例,介入栓塞组23例。传统手术组行剖宫产术治疗,介入栓塞组实施髂内动脉栓塞术联合剖宫产术。检测并比较两组手术时间、术中出血量、住院时间、术后血β-hCG恢复正常时间、术后阴道流血时间、新生儿Apgar评分、术后不良事件发生率等。结果介入栓塞组的手术时间、术中出血量、住院时间、术后血β-hCG恢复正常时间、术后阴道流血时间、疼痛持续时间为(53.24±7.85)min、(623.34±143.56)mL、(7.10±1.24)d、(15.42±1.35)d、(2.12±0.58)d、(3.25±0.86)d,均低于传统手术组[(85.37±21.45)min、(923.42±224.56)mL、(10.56±0.56)d、(25.41±6.54)d、(5.62±1.01)d、(6.23±2.47)d],差异均有统计学意义(P<0.05)。两组患儿出生后1、5、10 min的Apgar评分比较差异无统计学意义(P>0.05)。介入栓塞组的疼痛、发热、切口感染等术后并发症发生率为47.83%、21.74%、0,均显著低于传统手术组(85.71%、71.43%、14.29%),差异均有统计学意义(P<0.05)。介入栓塞组手术成功率、栓塞后出血立即停止率为100.00%、95.65%,显著高于传统手术组(85.71%、80.95%),差异均有统计学意义(P<0.05)。结论髂内动脉栓塞术联合剖宫产术可有效改善凶险性前置胎盘并大出血患者围手术期指标,降低并发症发生风险,提升手术成功率,值得临床推广应用。

髂内动脉钙化对肾移植受者移植物功能延迟恢复和近期预后的影响

目的分析髂内动脉钙化与肾移植受者移植物功能延迟恢复(DGF)及近期预后的相关性。方法回顾性分析222例肾移植受者的临床资料。依据肾功能恢复情况分为DGF组(50例)和移植物功能正常恢复(IGF)组(172例),根据是否合并髂内动脉重度钙化将DGF组和IGF组分为DGF高危组(22例)、DGF低危组(28例)、IGF高危组(41例)以及IGF低危组(131例)。比较两组供受者临床资料,总结肾移植术后DGF及髂内动脉钙化发生情况,分析肾移植术后发生DGF的危险因素、髂内动脉钙化与临床指标的相关性以及DGF合并髂内动脉重度钙化受者近期预后。结果本研究中DGF发生率为22.5%(50/222)。肾移植受者中28.4%(63/222)合并髂内动脉重度钙化,DGF组中44%(22/50)合并髂内动脉重度钙化,高于IGF组中的23.8%(41/172)(P<0.05)。单因素分析结果显示供者终末血清肌酐(Scr)高、男性供者,受者甘油三酯水平高和髂内动脉重度钙化是肾移植术后发生DGF的危险因素(均为P<0.05)。多因素logistic回归分析显示供者Scr≥143μmol/L及受者髂内动脉重度钙化是肾移植术后发生DGF的独立危险因素(均为P<0.05)。相关性分析结果显示髂内动脉钙化与受者年龄和肾动脉吻合方式均呈弱相关(均为P<0.05)。DGF组受者术后1个月的Scr高于IGF组,估算肾小球滤过率(eGFR)低于IGF组(均为P<0.05);DGF高危组受者术后12个月的e GFR低于DGF低危组、IGF高危组以及IGF低危组(均为P<0.05)。结论髂内动脉钙化不仅是影响移植肾功能恢复的危险因素,也对移植肾功能的近期预后造成不良影响。

中孕期子宫动脉及髂内动脉彩色多普勒超声预测不良妊娠结局的价值

目的应用彩色多普勒超声观测中孕期子宫动脉及髂内动脉血流频谱的变化,分析其预测不良妊娠结局的价值。方法收集我院中孕期子宫动脉血流频谱出现舒张早期切迹的孕妇46例(切迹组)和子宫动脉舒张早期无切迹的正常孕妇51例(对照组),应用彩色多普勒超声获得子宫动脉及髂内动脉的收缩期与舒张期峰值血流速度比值(S/D)、搏动指数(PI)、阻力指数(RI),以及髂内动脉峰值血流加速时间(IIA-AT)、内径及血流量,比较两组上述参数的差异,分析子宫动脉及髂内动脉血流参数对不良妊娠结局的检出率。结果与对照组比较,切迹组子宫动脉S/D、PI、RI和髂内动脉S/D均升高,IIA-AT延长,差异均有统计学意义(均P<0.05)。切迹组发生不良妊娠结局9例;对照组发生不良妊娠结局1例。子宫动脉舒张早期切迹联合IIA-AT、髂内动脉S/D对不良妊娠结局的检出率(50.0%)高于子宫动脉舒张早期切迹单独应用(19.6%),尤其对子痫前期的检出价值更高(40.0%vs.10.9%),差异均有统计学意义(均P<0.05)。结论中孕期子宫动脉舒张早期切迹联合髂内动脉血流频谱参数可以预测不良妊娠结局的发生,为临床及早诊疗提供客观依据。

混合痔手术治疗概况

临床治疗混合痔的手术法分为传统中医手术法和微创手术法。传统中医手术方法包括枯痔钉法、中药注射法、中医结扎法、外剥内扎术等;微创手术法包括痔上黏膜环切术、选择性痔上黏膜吻合术、自动弹力线套扎术、超声多普勒引导下痔动脉结扎术等。目前,每种术式都存在一些问题:传统术式疗效突出,术后不易复发,但其对机体损伤较大,操作范围为神经丰富的齿线附近,增加了患者术后的疼痛感等不良反应的发生率,患者术后恢复较慢,但术中配合中药注射法可有效缓解术后出血、疼痛等不良反应;西医微创疗法较传统术式痛苦小,恢复快,患者接受度高,但仍存在远期易复发和操作不规范导致的手术安全性等问题。因此,临床应该熟悉各种术式的适应证和禁忌证,规范操作,同时应根据病情轻重、患者自身的身体条件以及本人的意愿等选择合适的手术方式,将患者的痛苦降到最低。今后,应详细研究肛肠的解剖结构和痔疮的发病机理,不断探索手术术式,寻求既能根治混合痔,又能减轻患者痛苦的方法。