凶险性前置胎盘合并胎盘植入剖宫产术中腹主动脉远端球囊阻断的临床疗效

目的分析剖宫产术中腹主动脉远端球囊阻断对于治疗凶险性前置胎盘合并胎盘植入的临床疗效。方法回顾性分析72例凶险性前置胎盘合并胎盘植入产妇的资料。其中53例(阻断组)于剖宫产术前预留腹主动脉球囊导管,术中暂时阻断腹主动脉血流;19例(未阻断组)未留置腹主动脉球囊导管,直接行剖宫产手术。比较2组术中、术后情况及新生儿情况。结果球囊阻断组术中出血量、术中输血量、子宫切除率均低于未阻断组(P均0.05),2组间术后转入重症监护室(ICU)的比例及ICU住院时间差异均有统计学意义(P均0.05),手术时间、术后感染发生率及术后住院总时间差异均无统计学意义(P均0.05)。2组间新生儿体质量及出生后5min、10min的Apgar评分差异均无统计学意义(P均0.05)。结论凶险性前置胎盘合并胎盘植入剖宫产术中行腹主动脉远端球囊阻断安全可行,可有效减少术中出血及输血量,降低子宫切除率。

Clinical curative effect of balloon occlusion of distal abdominal aorta in cesarean section for patients with pernicious placenta previa and placenta accreta

Objective To analyze the clinical efficacy of balloon occlusion of distal abdominal aorta for patients with pernicious placenta previa and placenta accreta. Methods Data of 72 patients with pernicious placenta previa and placenta accreta were retrospectively analyzed. There were 53 cases (occlusion group) reserved balloon occlusion in abdominal aorta before cesarean section, which can temporarily blocked abdominal aortic blood flow during operation. The other 19 cases (non-occlusion group) underwent cesarean section without balloon occlusion of abdominal aorta. The intraoperative, postoperative situations and the birth state of newborn of the two groups were compared. Results The bleeding, blood transfusion and hysterectomy rate during the operation in occlusion group were less than those in non-occlusion group (all P<0.05). Differences of the rate of postoperative transferring to intensive care unit (ICU) and the time in ICU were statistically significant between two groups (both P <0.05). No statistical difference of operation time, postoperative total hospital stay time and the rate of postoperative infection was found between two groups (both P>0.05). There was no statistical difference of newborns weight and Apgar scores (5 min and 10 min after birth) between two groups (all P>0.05). Conclusion The balloon occlusion of distal abdominal aorta in cesarean section for patients with pernicious placenta previa and placenta accreta is safe and feasible, which can effectively reduce the intraoperative bleeding, the blood transfusion and the risk of hysterectomy.