再次评价中孕期中央性前置胎盘状态引产预防性应用子宫动脉栓塞术的临床效果

目的探讨子宫动脉栓塞术在中孕期中央性前置胎盘状态引产中的预防出血效果及不良反应。 方法采用回顾性研究方法对2011年1月至2014年12月在广州医科大学附属第三医院行中孕期中央性前置胎盘状态引产的79例患者临床资料进行分析。将羊膜腔注射乳酸依沙吖啶注射液联合口服米非司酮，同时使用子宫动脉栓塞术引产的29例患者作为栓塞组(其中孕20～27^＋6周18例，<20周11例)；将只采用羊膜腔注射乳酸依沙吖啶注射液联合口服米非司酮的50例患者作为对照组(其中孕20～27^＋6周20例，<20周30例)；分别对两组患者的引产时间、出血量、术后发热率、术后疼痛强度和月经恢复时间等进行比较。 结果(1)引产时间：孕20～27^＋6周患者中栓塞组除1例因引产失败转为剖宫取胎外，其余17例为(45.94±5.80)h，对照组为(41.23±7.59)h(t＝1.85，P<0.05)；两组<20周患者引产时间分别为(49.36±7.80)h和(41.23±13.85)h(t＝1.83，P<0.05)差异有统计学意义。(2)出血量：20～27^＋6周栓塞组出血量少于对照组，分别为(294±60)ml和(356±81)ml(t＝2.64，P<0.01)，差异有统计学意义；两组<20周患者出血量差异无统计学意义。(3)栓塞术后疼痛评分：20～27^＋6周两组患者分别为(8.70±0.90)分和(2.11±0.50)分(t＝13.67，P<0.01)差异有统计学意义；<20孕周两组患者分别为(7.27±1.80)分和(1.65±0.48)分(t＝13.39, P<0.01)，差异有统计学意义。(4)术后发热：20～27^＋6周两组患者分别为64.71%和5%(t＝18.26，P<0.01)，<20周两组患者分别为63.64%和6.67%(t＝11.25, P<0.01)，差异有统计学意义。 结论(1)子宫动脉栓塞术对于孕周20～27^＋6周的胎盘前置状态引产出血有积极的预防作用，但对孕周<20周的前置胎盘状态引产预防出血意义不大。(2)子宫动脉栓塞术可能会延长引产时间，增加产后疼痛强度及发热率，临床应用需谨慎。(3)在中孕期前置胎盘状态引产手术中，娴熟的产科处理技术对术中预防和减少出血可以起到积极的作用。

Evaluating the effects of preventive uterine artery embolization on the pregnancy with complete placenta previa undertaking labor induction in second trimester

ObjectiveTo evaluate the effects of uterine artery embolization on preventing the pregnancy with complete placenta previa hemorrhage during induced labor in second trimester and its adverse effects. MethodsWe retrospectively analyzed 79 cases of labor induction on pregnancy with complete placenta previa during second trimester, who were admitted to the third affiliated hospital of Guangzhou medical university during January 2011 to December 2014. There were divided into embolization group and control group. In embolization group, 29 patients were induced labored by using rivanol and mifepristone. On the same time, they were performed uterine artery embolization (UAE). 18 cases were 20-27^{+ 6} gestational weeks and 11 cases were less than 20 gestational weeks. In control group, 50 patients were induced labored by using rivanol and mifepristone. 20 cases were 20-27^{+ 6} gestational weeks and 30 cases were less than 20 gestational weeks. The timing of labor induction, the number of loss bleeding, the rate of fever, the pain degree and the recovery phase of menstruation were compared between embolization group and control group. Results(1) Excepted one performed cesarean section due to fail of induced labor, the timing of induced labor in 20-27^{+ 6} gestational weeks was (49.36±7.80) hour in embolization group and was(41.23±7.59)hour in control group. Under 20 gestational weeks, the timing of induced labors was (49.36±7.80) h and (41.23±13.85) h in embolization group and control group, respectively. Compared in the timing of induced labored between two groups, there was significant difference.(2)Compared in the number of loss bleeding in 20-27^{+ 6} gestational weeks between two groups, 294±60 ml and 356±81 ml were respectively in embolization group and control group, which was significant difference. There war not significant difference in less than 20 gestational weeks. (3)Compared in the pain degree in 20-27^{+ 6} gestational weeks between two groups, the score was respectively 8.70±0.90 and 2.11±0.50 in embolization group and control group, which was significant difference. Compared in the pain degree in less than 20 gestational weeks, the score was 7.27±1.80 and 1.65±0.48 respectively in embolization group and control group, which was significant difference.(4) The rate of fever was 61.11% in 20~27^{+ 6} gestational weeks of embolization group and 5% in control group, which was significant difference. Compared in less than 20 gestational weeks between two groups, there was respectively 63.63% and 6.67%, which also were significantly difference. Conclusions(1) UAE played a positive role on preventing hemorrhage due to central placenta previa in more than 20 gestational weeks. But there was not on less than 20 gestational weeks. (2) UAE could prolong the time of labor induction, increase the pain degree and the rate of fever. So we used UAE cautiously. (3) In induced labor with central placenta previa during second trimester, adept skill played a positive role on preventing and decreasing hemorrhage.