腹主动脉球囊封堵治疗凶险性前置胎盘 伴植入的Meta分析

摘要:目的 系统评价腹主动脉球囊封堵治疗凶险性前置胎盘（PPP）伴植入的有效性及安全性。方法 计算机 检索PubMed、Cochrane Library、Web of Science、EMbase 数据库获取文献，检索时间均为数据库建库至2018年3月。 由2名评价员按纳入与排除标准独立进行文献筛选、数据提取和质量评价后，采用RevMan 5.3软件进行Meta分析。 结果 最终纳入6项回顾性队列研究，共515例患者（球囊组342例，对照组173例）。Meta分析结果显示：球囊组术 中出血量少于对照组（SMD=-0.51，95%CI：-0.80～-0.23，P=0.000 4）；球囊组子宫切除率低于对照组（OR=0.40， 95%CI：0.21～0.74，P=0.003）；而 2 组间红细胞输注量（SMD=-0.23，95%CI：-0.54～0.07，P=0.13）和术后住院时间 （SMD=-0.23，95%CI：-0.12～0.58，P=0.20）差异无统计学意义；腹主动脉球囊封堵相关不良反应主要为穿刺点血肿 和动/静脉血栓形成，对症治疗后均缓解。结论 腹主动脉球囊封堵治疗PPP伴植入可减少术中出血量，降低子宫切 除率，且无严重相关并发症报道。但上述结论仍需更多高质量、大样本的研究进一步予以验证。

Treatment of the perilous placenta previa patients with placenta implantation by abdominal aorta balloon occlusion: a Meta-analysis

Abstract：Objective To evaluate the safety and efficacy of abdominal aorta balloon occlusion in the treatment of perilous placenta previa (PPP) patients with placenta implantation. Methods The literature data were retrieved from the electronic databases of PubMed, Cochrane Library, Web of Science and EMbase. The retrieval time was from the database construction to March 2018. Two reviewers independently screened literature extracted data and evaluated the quality of the included studies according to the inclusion and exclusion criteria. Then, Meta-analysis was performed by RevMan 5.3 software. Results Finally, 6 retrospective cohort studies involving 515 patients (342 cases in balloon group and 173 cases in control group) were included. The results of Meta-analysis showed that the intraoperative blood loss was less in the balloon group than that of the control group (SMD=-0.51, 95%CI:-0.80- -0.23, P=0.000 4), and the hysterectomy rate was lower in the balloon group than that of the control group (OR=0.40, 95%CI: 0.21-0.74, P=0.003). But there were no significant differences in the amount of packed red blood cell transfusion (SMD=-0.23, 95%CI: -0.54 - 0.07, P=0.13) and the length of postoperative hospitalization (SMD=- 0.23, 95%CI: - 0.12-0.58, P=0.20) between the two groups. The associated adverse reactions of abdominal aorta balloon occlusion included hematoma of the puncture point and arterial/vein thrombosis. The above complications were all relieved after conservative treatments. Conclusion The treatment of PPP patients with implantation by abdominal aorta balloon could decrease the amount of bleeding during the operation, reduce the hysterectomy rate, and has no serious related complications. However, the above conclusions still need more high quality and large sample studies to futher verify.