不同动脉阻断术在凶险性前置胎盘伴胎盘植入剖宫产中的应用比较

目的:比较腹主动脉球囊阻断术、双侧髂内动脉球囊阻断术和子宫动脉栓塞术3种不同动脉阻断术在凶险性前置胎盘伴胎盘植入产妇剖宫产中的效果。方法:回顾性分析2014年10月至2017年12月在武汉中心医院剖宫产分娩的103例凶险性前置胎盘伴胎盘植入产妇的临床资料,分为子宫动脉栓塞术组(UA组,n=30),腹主动脉球囊阻断术组(AA组,n=34)和双侧髂内动脉球囊阻断术组(IA组,n=39)。比较3组产妇置管情况,剖宫产手术情况及产后情况。结果:3组产妇剖宫产术前置管术时间两两比较,差异均有统计学意义(P<0.05),UA组最短为5.32±2.34分钟,IA组最长为32.18±6.31分钟。UA组胎儿基本未受辐射,AA组胎儿透视时间和接受辐射量显著少于IA组,差异有统计学意义(9.48±3.21秒vs 54.23±23.85秒,t=10.846,P=0.000;2.94±0.78 mGY vs 21.29±13.84 mGY,t=7.714,P=0.000)。3组产妇剖宫产情况比较:UA组手术时间最长(143.45±25.43分钟),AA组手术时间最短(104.23±21.38分钟);UA组的术中出血量、输血比率、输血量及子宫切除率显著高于其他两组(P<0.05);UA组产后血红蛋白浓度显著低于其他两组(P<0.05)。3组产妇剖宫产术后情况比较,差异无统计学意义(P>0.05)。结论:腹主动脉和髂内动脉球囊术对凶险性前置胎盘伴胎盘植入产妇剖宫产术中出血控制效果较好,子宫保留率更高。腹主动脉球囊阻断术对母体和胎儿的放射安全性更好。

Comparison of Application of Different Arterial Blockade Methods in Caesarean Section with Pernicious Placenta Previa and Placenta Accrete

Objective:To compare the application value of abdominal aortic balloon occlusion,bilateral internal iliac artery aortic balloon occlusion and uterine artery embolization in caesarean deliveries with pernicious placenta previa and placenta accrete.Methods:A retrospective study of total 103 caesarean deliveries with pernicious placenta previa and placenta accrete in The Central Hospital of Wuhan from October 2014 to December 2017 was performed.Based on the different methods,they were devided into the uterine artery group(UA group,n=30),the abdominal aorta group(AA group,n=34)and the iliac artery group(IA group,n=39).The conditions of balloon stent operation,caesarean delivery,postpartum and newborns were compared between three groups.Results:There was significant difference in catheterization duration before delivery in three groups when compared with each other(P<0.05).The shortest time to perform catheterization was observed in UA group(5.32±2.34min)and longest time in IA group(32.18±6.31min).There was little fetal radiation exposure in UA group.The time of fetal exposure and the radiation dose in AA group were significantly lower than those in IA group(9.48±3.21 s vs 54.23±23.85 s,t=10.846,P=0.000;2.94±0.78 mGY vs 21.29±13.84 mGY,t=7.714,P=0.000).The operation time in UA group(143.45±25.43min)was the longest,and in AA group(104.23±21.38min)the shortest.The intraoperative blood loss,transfusion ratio,transfusion volume and hysterectomy rate in UA group were significantly higher than those in other two groups(P<0.05).The postpartum hemoglobin concentration in UA group was significantly lower than that in other two groups(P<0.05).There was no significant difference among the three groups regarding postoperative condition(P>0.05).Conclusions:Both abdominal aortic balloon occlusion and internal iliac artery balloon occlusion are with better effect of controlling blood loss during operation and with a higher chance of intact uterus.The abdominal aortic balloon stent is more safer for fetus and mothers regarding the radiation exposure.