不同动脉阻断平面对凶险性前置胎盘剖宫产术中出血控制效果的对比研究

目的:对比研究髂总动脉与腹主动脉不同水平的球囊阻断,在凶险性前置胎盘剖宫产术中出血的控制效果、并发症的发生、置管时所受射线曝露剂量及子宫切除率等方面的差异。方法:63例凶险性前置胎盘产妇,分为髂总动脉组33例及腹主动脉组30例,剖宫产术前预置球囊导管于不同动脉阻断平面。髂总动脉组经双侧股动脉入路,预置球囊导管于双侧髂总动脉主干,腹主动脉组经单侧股动脉入,预置球囊导管于腹主动脉(肾动脉开口稍下平面)。待胎儿娩出后,立即充盈球囊阻断相应动脉血流。记录两组患者手术时间、术中失血量、24h失血总量、术后住院时间及子宫切除率。结果:63例剖宫产术前行髂总动脉与腹主动脉内动脉预置球囊导管均获得成功,两组患者透视时间和X射线照射剂量比较,差异有统计学差异(P<0.05)。腹主动脉组患者的术中失血量、24h失血总量低于髂总动脉组患者,差异有统计学意义(P<0.05)。结论:腹主动脉组仅需单侧入路放置球囊导管,操作时间短,胎儿及母体所受射线照射剂量明显减少,射线下暴露时间明显缩短。虽然手术时间、术后住院时间等方面无显著差异,但术中失血量、24h失血总量低于髂总动脉组,较髂总动脉预置球囊具有优势。

The comparative study of different arterial occlusion planes in controlling the hemorrhage of the dangerous placenta previa

Objective To compare and study the differences of balloon occlusion of common iliac artery and abdominal aorta at different levels in the control effect of hemorrhage,occurrence of complications,radiation exposure dose and uterine resection rate during cesarean section of the dangerous placenta previa.Methods 63 patients with dangerous placenta previa were divided into the common iliac artery group (33 cases) and the abdominal aorta group (30 cases).In the common iliac artery group,bilateral femoral artery approach was adopted,and balloon catheter was prepositioned in the trunk of bilateral common iliac artery.In the abdominal aorta group,unilateral femoral artery was inserted,and balloon catheter was prepositioned in the abdominal aorta (slightly lower plane of the renal artery opening).After delivery,immediately block the corresponding arterial blood flow by filling the balloon.The operative time,intraoperative blood loss,total blood loss at 24 h,postoperative hospital stay and uterine resection rate of the two groups were recorded.Results 63 cases of cesarean section before the operation of the common iliac artery and the internal abdominal aortic artery balloon catheter are successful,the two groups of patients fluoroscopy time and X-ray dose comparison,there is a statistical difference (P < 0.05).The intraoperative blood loss and total blood loss at 24 h in the abdominal aorta group were lower than those in the common iliac artery group,with statistically significant differences (P < 0.05).Conclusion in the abdominal aorta group,only the balloon catheter was placed in the unilateral approach,the operation time was short,the radiation dose of the fetus and the mother was significantly reduced,and the exposure time was significantly shortened.Although there was no significant difference in operative time,postoperative hospitalization,etc.,intraoperative blood loss and total blood loss at 24 h were lower than those in the common iliac artery group,which had an advantage over the prepositioned balloon in the common iliac artery group.