血管阻断联合经子宫后路子宫修补术治疗穿透性胎盘植入的疗效观察

目的:比较并分析血管阻断联合经子宫后路子宫修补术治疗与低位腹主动脉球囊阻断术联合子宫修补术治疗穿透性胎盘植入的临床疗效。方法:选择2014年3月至2018年3月在本院住院分娩的穿透性胎盘植入孕妇67例临床资料进行回顾性分析。根据手术方式不同分为子宫后路组和球囊阻断组。子宫后路组31例采用血管阻断联合经子宫后路子宫修补术治疗,球囊阻断组36例采用低位腹主动脉球囊阻断术联合子宫修补术治疗。比较两组剖宫产围手术相关指标、剖宫产术后并发症、非产科因素并发症、胎儿透视时间、新生儿结局。结果:子宫后路组和球囊阻断组在剖宫产手术时间、术中出血量、血浆输入量及术后住院时间方面比较,差异均无统计学意义(P>0.05);子宫后路组和球囊阻断组产后24小时出血量、弥散性血管内凝血(DIC)发生率、下肢血栓发生率及产褥期感染发生率比较,差异无统计学意义(P>0.05);子宫后路组非产科相关并发症总发生率(3.23%)低于球囊阻断组(27.78%),差异有统计学意义(P<0.05),子宫后路组胎儿无X线辐射暴露,球囊阻断组胎儿透视平均时间8.28±2.54秒;两组产妇术后子宫恢复及月经复潮情况比较,差异无统计学意义(P>0.05);子宫后路组和球囊阻断组新生儿体质量、新生儿Apgar评分、新生儿窒息发生率及远期随访结果比较,差异无统计学意义(P>0.05)。结论:血管阻断联合经子宫后路子宫修补术治疗与低位腹主动脉球囊阻断术联合子宫修补治疗穿透性胎盘植入临床疗效相似,但血管阻断联合经子宫后路子宫修补术治疗非产科因素并发症较少,且不接受X线辐射,安全性更高。

Curative Effect of Vascular Occlusion Combined with Posterior Uterus Repair on Penetrating Placenta Accreta

Objective:To compare and analyze the clinical curative effects of vascular occlusion with posterior uterine repair and low abdominal aortic balloon block with uterine repair on penetrating placentaaccreta.Methods:The clinical data of 67 pregnant women with penetrating placenta acceretadeliveringin the hospital from March 2014 to March 2018 were retrospectively analyzed.According to different surgical methods,they were divided into the posterior uterus group and the balloon block group.31 patients in the posterior uterus group received vascular occlusion with posterior uterus repair.36 patients in the balloon block group received low abdominal aortic balloon block with uterine repair.The perioperative related indicators of cesarean section,complications after cesarean section,complications of non-obstetric factors,fetal fluoroscopy time and neonatal outcome were compared between the two groups.Results:There was no significant difference inoperation time of cesarean section,intraoperative blood loss,plasma input quantity or postoperative hospital stay between the two groups(P>0.05).There was no significant difference in the amount of bleeding at 24 h after birth,incidence of disseminated intravascular coagulation(DIC),incidence of lower extremity thrombosis or incidence of puerperousinfection between the two groups(P>0.05).The incidence of non-obstetriccomplications in posterior uterus group(3.23%)was lower than that in balloonblock group(27.78%)(P<0.05).The fetuses in the posterior uterus group were not exposed to X-ray.The average fluoroscopy time of fetus in the balloonblock group was 8.28±2.54 s.There was no significant difference in postoperative uterine recovery or menstrual recovery between the two groups(P>0.05).There was no significant difference in neonatal weight,neonatal Apgar score,incidence of neonatal asphyxia or long-term follow-up resultsbetween the two groups(P>0.05).Conclusions:The clinical curative effects of vascular occlusion with posterior uterine repair and low abdominal aortic balloon block with uterine repair are similar.The incidence of complications of non-obstetric factors with the former is lower.It isalso safer without X-ray radiation.