腹主动脉球囊阻断辅助下提拉宫颈行子宫下段螺旋式缝合术在植入型凶险型前置胎盘中的应用26

目的:对植入型凶险型前置胎盘的孕妇,计划性剖宫产术中采用腹主动脉球囊阻断辅助下提拉宫颈,行子宫下段螺旋式缝合术的有效性和安全性进行评估.方法:选取18例经B型彩色超声和磁共振成像(MRI)联合诊断为植入型凶险型前置胎盘的孕妇,均行计划性剖宫产(保留子宫意愿),手术孕周(36.78±1.63)周.剖宫产术前行腹主动脉球囊预置管,娩出胎儿并结扎脐带后,采用腹主动脉球囊临时阻断,剥离胎盘,提拉宫颈,行子宫下段螺旋式缝合术.术后必要时行双侧子宫动脉栓塞术.回顾分析患者的术中失血量、术后24 h失血量、子宫切除率、输血量、预置腹主动脉球囊时间、腹主动脉球囊阻断时间、胎儿和产妇的辐射剂量、术后血管并发症、外科并发症及产褥期并发症.结果:18例孕妇术中视诊和术后病理均诊断为凶险型前置胎盘伴胎盘植入.剖宫产术中失血量(2061±1709)ml,术后24h失血量(228±141)ml,子宫切除率5.55%,12例输血,输注红细胞悬液量(1148±1061)ml,血浆量(491±403)ml.腹主动脉球囊预置管时间为(4.17±1.25)min,腹主动脉球囊阻断时间为(15.83±8.01)min;胎儿辐射剂量(9±5.50)mGy,产妇辐射剂量(43.29±47.64)mGy.外科并发症1例(膀胱损伤),无血管并发症和产褥期并发症发生.结论:腹主动脉球囊阻断辅助下提拉宫颈行子宫下段螺旋式缝合术是控制植入型凶险型前置胎盘患者术中、术后出血与保留子宫的一种安全和有效的联合治疗方法.

Clinical application of spiral suture of the lower uterine segment with temporary aortic balloon occlusion in the patients with implantable pernicious placenta previa

Objective:To evaluate the effectiveness and safety of the spiral suture of the lower uterine segment in patients with implantable pernicious placenta previa( PPP) in as-sistance of the temporary intraoperative aortic balloon occlusion. Methods:18 patients who were preoperatively diagnosed with implantable pernicious placenta previa ( PPP ) by B-type color Doppler ultrasonography and magnetic resonance imaging ( MRI ) and who underwent prophy-lactic aortic catheterization before scheduled caesarean section ( CS ) during ( 36 . 78 ± 1 . 63 ) weeks were included in the study. After delivery of the fetus and ligation of the umbilical cord, we stripped the placenta,pulled the cervix and sutured up the lower uterine spiral,while bilater-al uterine artery embolization would be performed,whenever necessary. We analyzed the clinical data of the study population,the postoperative blood loss,uterine resection rate,blood transfu-sion,preoperative abdominal aortic balloon time,abdominal aortic balloon occlusion time,fetal and maternal radiation dose,and puerperium complications retrospectively. Surgery- and cathe-terization-related complications were also reported. Results:All of these 18 patients were surgi-cally confirmed as pernicious placenta previa with placenta accrete during surgery and patholog-ical diagnosis. The median estimated blood loss during surgery was ( 2061 ± 1709 ) ml and 24 hours postoperative blood loss were (228±141)ml,respectively. Hysterectomy was performed in five (5. 55%) patients and uterine artery embolization in 8(44. 4%) patients. Of 12 patients had blood transfusions and the amount of erythrocyte suspension and plasma were ( 1148 ± 1061) ml and (491±403) ml,respectively. The abdominal aortic balloon preconditioning time and abdominal aortic balloon occlusion time were (4. 17±1. 25) min and (15. 83±8. 01) min. The fetal radiation dose was (9 ±5. 50) mGy,while the maternal dose was (43. 29 ±47. 64) mGy. One patient experienced surgery-related complications ( bladder injury ) , and no major catheterization-related complications and puerperal complications were observed. Conclusion:Assisted by the abdominal aorta balloon occlusion,the spiral suture of inferior uterine segment is a safe and effective combination therapy for controlling intraoperative and postoperative hemor-rhage,and might be helpful to prevent hysterectomy in the patients with implantable pernicious placenta previa( PPP) and wishing to preserve fertility.