清除胎盘后子宫重建术与胎盘原位保留在胎盘植入治疗中的对比研究

目的:比较清除胎盘后子宫重建术与胎盘原位保留+子宫动脉栓塞术对于胎盘植入患者保留子宫的优劣。方法:回顾2011年1月至2013年12月我院胎盘植入病例,分别接受清除胎盘后子宫重建术(PEUR组)和胎盘原位保留后子宫动脉栓塞术(PIS-UAE组),比较两组患者的临床结局。结果:共纳入61例,其中PEUR组35例,PIS-UAE组26例。与PEUR组相比,PIS-UAE组手术时间更短(107分钟vs 154分钟,P<0.05);但产褥感染率10例(38.5%)vs 2例(5.7%),P<0.05]及晚期产后出血率16例(61.5%)vs 2例(5.7%),P<0.001]显著升高,且住院时间更长(7.5天vs 5天)。两组患者穿透型植入占比及术中膀胱损伤率无差异(P>0.05)。PIS-UAE组因术后出血需进一步手术止血者(开腹清除胎盘、再次UAE、子宫切除)占比显著高于PEUR组。PIS-UAE组子宫保留率84.6%,PEUR组97.1%。随访至2019年6月,共有17例(17/56,30.4%)再次妊娠,1例切口妊娠,16例宫内妊娠。结论:对于胎盘植入患者的治疗,清除胎盘后子宫重建术并发症少且子宫保留率高,优于胎盘原位保留联合子宫动脉栓塞术。

Strategy of Placenta Extirpation Followed by Uterine Remolding and Leave Placenta in Situ Followed by Uterine Artery Embolization for Patients with Placenta Accreta Spectrum Disorders:a Comparative Study

Objective:To assess whether removal or retention of placenta in placenta accreta spectrum disorders(PAS)is preferable for uterine preservation.Methods:Patients with PAS in our hospital from January 2011 to December 2013 were reviewed.The clinical outcomes of Placenta Extirpation followed by Uterine Remolding(PEUR)and Placenta In Situ-Uterine Artery Embolization(PIS-UAE)were compared.Results:During the study period,61 patients with PAS were enrolled,including 35 patients with PEUR strategy and 26 patients with PIS-UAE strategy.Compared with PEUR group,the PIS-UAE group showed shorter operation time(107 min vs 154 min,P<0.05).However,the PIS-UAE group suffered higher rates of puerperal infection and late postpartum hemorrhage(5.7%vs 38.5%;5.7%vs 61.5%,allP<0.05),and the length of hospital stay is much longer(7.5 days vs 5 days,P<0.05).The rates of percreta and injury of bladder was not significantly different between two groups.In PIS-UAE group,the rate of repeat further salvage surgery(clean the placenta via laparotomy,re-UAE,hysterectomy)to stop bleeding was higher than that in the PEUR group,allP<0.05.The uterine-preservation rate of PIS-UAE group was 84.6%while that of PEUR group was 97.1%.During the follow-up to June 2019,17 cases(17/56,30.4%)were pregnant again,1 case of incision pregnancy and 16 cases of intrauterine pregnancy.Conclusions:Placenta extirpation followed by uterine remolding was superior to leaving placenta in situ with high uterine-preservation rate.