不同方式在中晚期妊娠前置胎盘出血引产中的临床应用

摘要

目的 比较子宫动脉栓塞术结合利凡诺、米非司酮与单纯利凡诺结合米非司酮在中晚期妊娠前置胎盘出血引产中的临床应用效果. 方法 选择我院2014年5月～2016年5月收治的72例需要终止妊娠的中晚期妊娠前置胎盘患者作为研究对象,按引产方案进行分组:观察组38例,行子宫动脉栓塞术结合利凡诺、米非司酮治疗;对照组34例,采取利凡诺结合米非司酮治疗.比较两组患者引产中、产后大出血发生率、出血量、刮宫率、刮宫出血量、全子宫切除率、术后并发症发生情况,以及再次妊娠时间与再次妊娠成功率. 结果 观察组患者引产中、产后的出血量、刮宫出血量均少于对照组(P＜0.05),两组引产中及产后大出血发生率、刮宫率、全子宫切除率比较,差异均无统计学意义(P＞0.05).观察组患者未见失血性休克,且术后发热、阴道渗血、失血性休克发生率均小于对照组(P＜0.05),两组患者术后腹痛发生率比较无统计学差异(P＞0.05).所有患者随访12 ～23个月,平均随访(18.5±5.74)个月,两组患者的再次妊娠时间、再次妊娠成功率比较,差异均无统计学意义(P＞0.05). 结论 在中晚期妊娠前置胎盘出血引产中应用子宫动脉栓塞术可有效减少引产中、产后的出血量及产后并发症发生,且对患者的生育能力无明显影响,值得进一步研究应用.%Objective To compare the clinical effect of uterine artery embolization (UAE) combined with rivanol and mifepristone with simple rivanol combined with mifepristone in the treatment of placenta previa hemorrhage in the middle and late pregnancy.Methods A total of 72 patients with placenta previa in the middle and late pregnancy who needed to terminate the pregnancy were selected from May 2014 to May 2016.The patients were divided into two groups according to the induction of labor:38 patients as the observation group received the treatment of UAE combined with rivanol and mifepristone;34 patients as a control group were treated by simple rivanol combined with mifepristone.The postpartum hemorrhage,bleeding,curettage,total hysterectomy rate,postoperative complications,re-pregnancy time and re-pregnancy success rate were compared between two groups.Results The bleeding volume of the observation group was less than that of the control group during induced labor,after induced labor and after curettage (P ＜ 0.05).There was no statistical difference in the incidence of hemorrhage during the induced labor,the incidence of postpartum hemorrhage,curettage rate and total hysterectomy rate between two groups (P ＞ 0.05).Except abdominal pain,the post complications as fever,vaginal capillary hemorrhage and hemorrhagic shock were less in the observation group than those in the control group (P ＜ 0.05).All cases were followed up for 12 to 23 months with an average of (18.5 ± 5.74) months.No statistical differences in the time and successful rate of re-pregnancy between the two groups (P ＞ 0.05).Conclusion The UAE can effectively reduce the occurrence of postpartum hemorrhage and postpartum complications,and have no significant effect on the fertility of the patients in the treatment of placenta previa in the middle and late pregnancy,and it is worthy of further research and application.