• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>African journal of urology >Surgical strategies for placenta percreta invading the bladder and review of literature
【24h】

Surgical strategies for placenta percreta invading the bladder and review of literature

机译：胎盘侵袭膀胱的外科策略和文学审查

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Background:Major obstetric hemorrhage is the leading cause of maternal morbidity and mortality. In rare cases, life-threatening hematuria in pregnant women may result from invasion of the bladder by the placenta. We present our experience with 18 cases of placenta percreta with suspected bladder invasion.MethodsIt is a retrospective single-center study conducted over a period of 3?years. Total 18 patients of radiologically diagnosed placenta percreta were included in the study. All patients who are at risk for placenta percreta underwent prenatal sonograms. Patients of Placenta Accreta Spectrum presenting electively also underwent MRI pelvis. Elective patients who were high risk of placenta percreta underwent bilateral placement of the balloon catheter in internal iliac artery. In case of doubt regarding bladder invasion, patient underwent anterior cystotomy and posterior wall of the bladder was examined and proximity of the ureteric orifice to the placenta and amount of involvement of bladder wall was assessed. Ureteric catheter placement was used as adjuncts depending on the proximity of placental invasion with ureteric orifice. Postoperative outcomes in the form of maternal morbidity, maternal mortality, fetal mortality, postoperative bleeding, bladder status, vesicovaginal fistula, bladder capacity were all evaluated.ResultsIn our series, 17 cases all cases were diagnosed preoperatively by antenatal ultrasound and MRI. Only one patient presented with hematuria. Only in one patient, we attempted separation of placenta from bladder wall, and it resulted in profuse bleeding, and in rest, we excised the involved bladder. Partial cystectomy was done in 33.4% patients, 27% patients required bilateral placement of ureteric catheter due to proximity to the ureteric orifice. 33.4% patient underwent bilateral internal iliac artery ligation or balloon placement. Clot evaluation was needed in one patient. Intraoperatively—39% patients had uterus adhered to the bladder but no placental invasion into the bladder. One patient was managed with obstetric hysterectomy and methotrexate followed by clot evacuation and bilateral internal iliac artery ligation at a later date. One (5.6%) patient developed vesicovaginal fistula in postoperative period. There was one (5.6%) maternal mortality with no fetal mortality. On follow-up, patient had good bladder capacity, 3?weeks after the surgery.ConclusionMRI done preoperatively can help us guide regarding the extent or severity of placental invasion. Intraoperatively, anterior cystostomy should be done in suspected placenta percreta. Grade I or II accrete/percreta patients can be managed conservatively. Partial cystectomy with placement of bilateral ureteric catheter is safer and less morbid approach in tackling placenta percreta invading the bladder with mucosal involvement.
机译：背景：主要产科出血是母体发病率和死亡率的主要原因。在极少数情况下，孕妇的危及生命的血尿可能因胎盘引入膀胱而导致。我们展示了我们在怀疑膀胱侵犯的18例胎盘Percreta的经验.Hethodsit是一个在3年内进行的回顾性单中心研究。研究中，18例放射性诊断胎盘术患者纳入研究。所有面临胎盘Percreta的患者都接受了产前超声图。胎盘ACCRETA光谱患者均选拔地介绍MRI骨盆。在内部髂动脉内接受球囊导管的胎盘术患者的选择性患者在胎盘导管的双边放置。在关于膀胱入侵疑问的情况下，患者接受前膀胱切开术和膀胱后壁检查和输尿管孔口胎盘和膀胱壁的参与量的接近度进行了评估。输尿管导管放置用作辅助侵袭性，这取决于胎盘侵袭与输尿管孔口的邻近。毛母病发，孕产妇死亡率，胎儿死亡率，膀胱状态，脓疱病毒瘘，膀胱产能的术后结果全部评估。我们的系列术语，17例所有病例均通过产前超声和MRI诊断术。只有一名患者患有血尿。只有在一名患者中，我们尝试将胎盘从膀胱壁分离，它导致丰富的出血，静止，我们切除涉及的膀胱。部分膀胱切除术是在33.4％的患者中进行的，27％患者由于接近输尿管孔而要求输尿管导管的双侧放置。 33.4％患者接受双侧内部髂动脉结扎或气球放置。在一个患者中需要凝块评估。术中-39％的患者有子宫粘附在膀胱上，但没有胎盘侵入到膀胱中。一名患者用产科子宫切除术和甲氨蝶呤进行管理，然后在以后的凝结疏散和双侧内部髂动脉连接。术后一期（5.6％）患者发育了脓疱病瘘。孕产妇死亡率（5.6％）孕产病，没有胎儿死亡率。在随访，患者有良好的膀胱容量，3？周术前做了surgery.ConclusionMRI后可以帮助我们引导关于胎盘侵入的程度或严重性。术中，患前囊肿术应在疑似胎盘植物中进行。级别或II级Accrete / Percreta患者可以保守管理。在侵袭胎盘侵袭膀胱受累的侵袭膀胱植物中，部分膀胱切除术在胎儿植物切除时更安全，病态较低。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号