凶险型前置胎盘应用髂内动脉预置球囊治疗可行性和效果观察

目的：观察凶险型前置胎盘应用髂内动脉预置球囊治疗的可行性、安全性和效果。方法回顾性分析我院2013年1月至2015年6月凶险型前置胎盘42例孕妇资料，其中22例剖宫产前髂内动脉预置球囊，胎儿娩出后球囊立即充盈暂时止血；20例剖宫产前未作任何处置，前置胎盘于剖宫产术中处置，观察两组预后。结果预置组产妇术中出血量、平均输血量均少于常规组[(862.4±126.5) ml vs (1913.2±362.8) ml，(714.2±102.5) ml vs (1513.2±313.4) ml]，平均手术时间短于对照组[(81.4±20.4) min vs (112.3±28.7) min]，差异有统计学意义(P<0.05)。预置组术后24 h阴道出血量≥500 ml发生率和子宫切除率为18.18%(4/22)、4.55%(1/22)；常规组为75.00%(15/20)、20.00%(4/20)；两组比较差异有统计学意义(P<0.05)。预置组预置球囊平均照射剂量(31.6±7.2) mGy，明显低于安全剂量上限200 mGy标准。拔管后有1例发生穿刺点血肿，无其他并发症发生。结论髂内动脉预置球囊的作用是胎儿娩出后可暂时阻断髂内动脉血流，减少产后出血，为下一步救治赢得时间，可降低子宫切除率，而且安全性好，是切实可行的新手段。

Feasibility and effect of treating dangerous type of placenta previa with preseted balloon for internal iliac artery

Objective To observe the feasibility, safety, and effect of using preseted balloon for internal iliac ar-tery in the treatment of dangerous type of placenta previa. Methods The clinical data of 42 pregnant women with danger-ous type of placenta previa in our hospital from January 2013 to June 2015 were analyzed retrospectively. Twenty-two pa-tients were preseted with balloon for internal iliac artery before cesarean section, and the balloon filled immediately after delivery (group A) to stop the bleeding. Twenty patients received no pretreatment before cesarean section (group B). The prognosis was observed in the two groups. Results The amount of bleeding and blood transfusion in the group A were sig-nificantly less than those of group B [(862.4±126.5) ml vs (1913.2±362.8) ml,(714.2±102.5) ml vs (1513.2±313.4) ml], and the average operation duration of group A was significantly shorter than that of the control group [(81.4 ± 20.4) min vs (112.3±28.7) min], P<0.05. The rate of 24 h vaginal bleeding amount≥500 ml and the rate of hysterectomy was 18.18%(4/22) and 4.55% (1/22) in group A, significantly lower than 75.00% (15/20) and 20.00% (4/20) in the control group (P<0.05). The average dose of group A [(31.6±7.2) mGy] was significantly lower than the upper limit of safe dose (200 mGy). There was 1 case of puncture site hematoma, with no other complications occurred. Conclusion Preseted balloon for in-ternal iliac artery can temporary block the blood flow after delivery, reduce postpartum haemorrhage, and gain more time for further treatment, with good safety, which helps reduce the rate of hysterectomy and thus is worth to be recommended.