多学科联合救治植入性凶险型前置胎盘策略探讨

目的 探讨植入性凶险型前置胎盘的救治策略,提高孕产妇术中出血抢救成功率.方法 回顾性分析2012年8月至2014年6月收治的23例植入性凶险型前置胎盘的救治及处理方法.结果 23例患者无1例死亡,3例因3次剖宫产术后胎盘植入穿透膀胱,行子宫切除及泌尿外科协助行膀胱修补术;5例因胎盘植入面积过宽保守治疗无效后行子宫全切术,其余全部成功保留子宫.手术持续时间（94.8±33.2） min,术中平均失血（1600±558） mL.结论 提高产前诊断率,围术期麻醉科应联合产科、泌尿外科、介入科、输血科、检验科等多个学科,安全、有效的综合治疗是保障手术成功的关键.

Strategies of Combined Multidisciplinary Treatment for Implantable Dangerous Placenta Previa

Objective To investigate the treatment strategies of implantable dangerous placenta previa,and to improve the success rate of maternal blood loss.Method The treatment methods of 23 cases from August 2012 to June 2014 with dangerous placenta previa were analyzed retrospectively.Results There was no patients died among this 23 cases.3 cases of placenta implantation through bladder because of 3 times caesarean operation was given hysterectomy and surgical assist for repair of bladder; 5 cases were given hysterectomy because placenta implantation area is too wide.The remaining cases retained uterus successfully.The average blood loss was （1600 ± 558） mL.Duration of surgery was （94.8 ± 33.2） min.Conclusion Improving prenatal diagnosis rate and combining multi-disciplines,including obstetric anesthesiology,urology,interventional radiology,transfusion department,laboratory,etc.is a safe,effective and comprehensive treatment,and the key to successful operation of security.