现代妇产科进展2017，Vol.26Issue(10)：747-751,5.DOI:10.13283/j.cnki.xdfckjz.2017.10.003
腹主动脉球囊阻断辅助下提拉宫颈行子宫下段螺旋式缝合术在植入型凶险型前置胎盘中的应用26
Clinical application of spiral suture of the lower uterine segment with temporary aortic balloon occlusion in the patients with implantable pernicious placenta previa
摘要
Abstract
Objective:To evaluate the effectiveness and safety of the spiral suture of the lower uterine segment in patients with implantable pernicious placenta previa( PPP) in as-sistance of the temporary intraoperative aortic balloon occlusion. Methods:18 patients who were preoperatively diagnosed with implantable pernicious placenta previa ( PPP ) by B-type color Doppler ultrasonography and magnetic resonance imaging ( MRI ) and who underwent prophy-lactic aortic catheterization before scheduled caesarean section ( CS ) during ( 36 . 78 ± 1 . 63 ) weeks were included in the study. After delivery of the fetus and ligation of the umbilical cord, we stripped the placenta,pulled the cervix and sutured up the lower uterine spiral,while bilater-al uterine artery embolization would be performed,whenever necessary. We analyzed the clinical data of the study population,the postoperative blood loss,uterine resection rate,blood transfu-sion,preoperative abdominal aortic balloon time,abdominal aortic balloon occlusion time,fetal and maternal radiation dose,and puerperium complications retrospectively. Surgery- and cathe-terization-related complications were also reported. Results:All of these 18 patients were surgi-cally confirmed as pernicious placenta previa with placenta accrete during surgery and patholog-ical diagnosis. The median estimated blood loss during surgery was ( 2061 ± 1709 ) ml and 24 hours postoperative blood loss were (228±141)ml,respectively. Hysterectomy was performed in five (5. 55%) patients and uterine artery embolization in 8(44. 4%) patients. Of 12 patients had blood transfusions and the amount of erythrocyte suspension and plasma were ( 1148 ± 1061) ml and (491±403) ml,respectively. The abdominal aortic balloon preconditioning time and abdominal aortic balloon occlusion time were (4. 17±1. 25) min and (15. 83±8. 01) min. The fetal radiation dose was (9 ±5. 50) mGy,while the maternal dose was (43. 29 ±47. 64) mGy. One patient experienced surgery-related complications ( bladder injury ) , and no major catheterization-related complications and puerperal complications were observed. Conclusion:Assisted by the abdominal aorta balloon occlusion,the spiral suture of inferior uterine segment is a safe and effective combination therapy for controlling intraoperative and postoperative hemor-rhage,and might be helpful to prevent hysterectomy in the patients with implantable pernicious placenta previa( PPP) and wishing to preserve fertility.关键词
凶险型前置胎盘/胎盘植入/腹主动脉球囊阻断术/子宫下段螺旋式缝合术Key words
Pernicious placenta previa ( PPP )/Placenta accrete/Temporary balloon occlusion/Spiral suture of the lower uterine segment分类
医药卫生引用本文复制引用
殷茵,晋柏,孙丽洲,杨正强,夏金国,周欣..腹主动脉球囊阻断辅助下提拉宫颈行子宫下段螺旋式缝合术在植入型凶险型前置胎盘中的应用26[J].现代妇产科进展,2017,26(10):747-751,5.基金项目
江苏省妇幼健康科研项目(No:F201658) （No:F201658）
