腹主动脉球囊阻断术在凶险性前置胎盘剖宫产术中的应用

摘要

目的 总结腹主动脉球囊暂时阻断术在凶险性前置胎盘剖宫产术中的临床应用效果.方法 将2012年11月～2016年11月在成都市妇女儿童中心医院就诊的78例剖宫产术后确诊为凶险性前置胎盘孕妇分为A、B两组:A纽47例行腹主动脉球囊阻断法剖宫产术;B组31例行常规剖宫产术.分别将A、B两组根据术中胎盘剥离情况分为:正常剥离(A1、B1)、胎盘粘连(A2、B2)、胎盘植入(A3、B3)三个亚组,并分别比较亚组术中情况.分别在A组和B组内比较胎盘不同附着部位(子宫前壁、后壁或侧壁、前壁及后壁)在剖宫产术中情况.结果 A3较B3亚组在剖宫术中、术后24小时出血量均明显减少,同时DIC发生率、切除子宫率均明显降低,差异均有统计学意义(P＜0.05).胎盘附着于子宫前壁较后壁或侧壁、前壁及后壁在术中、术后24小时出血量均明显增多,DIC发生率、切除子宫率均明显升高.结论 在凶险性前置胎盘合并胎盘植入剖宫产术中行暂时腹主动脉球囊阻断术可明显减少术中出血及降低子宫切除等风险,胎盘有无植入、胎盘附着部位是决定子宫切除与否的关键.%Objective To investigated the effect of balloon occlusion of the abdominal aorta in pernicious placenta previa cesarean section(CS) . Methods 78 pregnant women delivered in Chengdu Women and Children Center Hospital from November 10,2012 to November 10,2016 diagosised pernicious placenta previa after cesarean section were divided into A group (47 cases) and B group (31 cases).A group was treated with abdominal aorta balloon occlusion method for caesarean section.B group was treated with conventional cesarean section.Based on the separation of the placenta from the uterine wall,A group and B groups were divided into normal separation group (A1 group and B1 group),placenta accreta group (A2 group and B2 group) and placenta increta group (A3 group and B3 group).The intraoperative situations of the groups were compared.The positions of the uterine wall of placenta attached including front wall,back or side wall,back and front wall) were compared.Results A3 group's intraoperative blood loss,blood loss within 24h postoperative were significantly reduced.The incidence rate of DIC,the percentage of uterus resection of A3 group were obviously reduced compared with those in B3 group (P ＜ 0.05).The intraoperative blood loss,blood loss within postoperative 24h,incidence of DIC,the percentage of uterus resection placenta attached to the front wall of the uterus were more significantly increased than that of back or side wall,front and back wall.Conclusion The balloon occlusion of the abdominal aorta in pernicious placenta previa and placenta increta cesarean section can obviously reduced the risk of bleeding and lower hysterectomy,this operation is suitable for clinical application;placenta implanted or not and the placenta adherent part are key determinants of hysterectomy or not.