目的：探讨球囊介入动脉闭塞术在凶险型前置胎盘合并胎盘植入围术期中的应用价值及时机。方法回顾性分析2010年1月~2014年12月广西医科大学附属南宁市第一人民医院45例凶险型前置胎盘合并胎盘植入产妇的临床资料,其中24例在膀胱镜检查+双侧输尿管逆行插管术+球囊介入髂总动脉闭塞术下施行二次剖宫产术(介入组),21例直接行二次剖宫产术(对照组)。比较两组的术中出血量、输血量、产后出血率、子宫切除发生率、并发症发生率、围生儿情况及住院费用等。结果介入组术中出血量[(1596.08±156.25)mL]、输血量[浓缩红细胞：(4.42±2.10)U],血浆：(534.34±36.12)mL]、产后出血率(29.17%)均明显低于对照组[(2296.08±184.38)mL、(7.27±2.05)U、(1164.10±75.26)mL、47.62%],差异均有统计学意义(P<0.05或P<0.01)；介入组住院费用[(27308.90±4390.99)元]明显高于对照组[(11679.10±845.93)元],差异均有高度统计学意义(P<0.01)；介入组子宫切除率、并发症发生率及围生儿情况与对照组比较,差异均无统计学意义(P>0.05)。结论凶险型前置胎盘合并胎盘植入在球囊介入动脉闭塞术下行剖宫产术,具有有效、安全、创伤小等优点,是一种新型有效的治疗措施。%Objective To explore the application value and operation time of interventional therapy in perioperative phase of pernicious placenta previa with placenta implantation. Methods The clinical data of 45 cases of pernicious placenta previa with placenta implantation from January 2010 to December 2014 in the First People's Hospital of Nan-ning City, Guangxi Medical University, were retrospectively analyzed. 24 patients were given cesarean section using cystoscopy and retrograde catheterization and arterial embolization (intervention group), and another 21 patients were given traditional cesarean section (control group). The comparisons of intraoperative bleeding volume, transfused blood volume,womb excision incidence rate, postpartum hemorrhage rate, complication incidence rate, hospitalized cost, ges-tational age and neonatal asphyxia rate between the two groups were done. Results Compared to the control group, the research group had less intraoperative blood loss [(1596.08±156.25) v s (2296.08±184.38) mL], less transfused blood vol-ume [RBC: (4.42±2.10) vs (7.27±2.05) U; plasma: (534.34±36.12) vs (1164.10±75.26) mL], lower postpartum hemor-rhage rate (29.17% v s 47.62%), more hospitalized cost [(27 308.90±4390.99) v s (11 679.10±845.93) yuan], the differ-ences were statistically significant (P< 0.05). In comparison of hysterectomy rate, complication incidence rate, gesta-tional age and neonatal asphyxia rate between the two groups, there were no statistical differences (P>0.05). Conclu-sion For patients with pernicious placenta previa with placenta implantation, interventional therapy of the ureter and artery catheter preoperatively, uterine embolism after delivery during cesarean section is a safe, effective and practica-ble comprehensive treatment method.
展开▼
