止血带联合子宫动脉结扎在凶险性前置胎盘伴重度胎盘植入术中的应用

目的:探讨止血带联合子宫动脉结扎术在凶险性前置胎盘伴重度胎盘植入术中的临床应用价值.方法:选择2016年1月至2018年12月于甘肃省妇幼保健院行术前胎盘超声评分诊断为凶险性前置胎盘伴重度胎盘植入并在术中确诊的74例孕妇作为研究对象,根据不同血管阻断方式分为子宫动脉栓塞组(28例)与止血带联合子宫动脉结扎(子宫动脉结扎...

Application of Tourniquet Combined with Uterine Artery Ligation in Pernicious Placenta Previa with Increta and Percreta

Objective:To evaluate the clinical value of tourniquet combined with uterine artery ligation in pernicious placenta previa with placenta accrete.Methods:This retrospectively study enrolled 74 patients diagnosed with placenta previa with placenta accrete at the Gansu Provincial Maternity and Child Care Hospital between January 2016 to December 2018.The patients were divided into two uterine artery embolization group(n=28) and tourniquet combined with uterine artery ligation group(n=46).The data of age、gravidity、cesarean section history ratio、intraoperative blood loss、intraoperative blood transfusion、Operation duration、hospital expenses、occurrence of complication and perinatal outcome were collected, and these data were compared between the two groups.Results:(1)There were no significant differences between in the severity of placenta implantation、age、gravidity、number of abortions、cesarean section history ratio and gestational week of termination between the two groups(P>0.05).(2)The intraoperative blood loss(1732.1±987.7 ml, 1392.4±974.8 ml),blood transfusion(1100.9±927.9 ml, 742.9±716.1 ml) and abnormal coagulation function(17.9%,6.5%) in uterine artery embolization group and tourniquet combined uterine artery ligation group, respectively, had no statistical significance(P>0.05).In artery embolization group and tourniquet combined with uterine artery ligation group, in operation time(169.5±69.2 min, 109.3±63.1 min),hysterectomy(17.9%,2.2%) and bladder rupture(21.4%,4.3%),the difference between the two groups was statistically significant(P<0.05).(3)In tourniquet combined with uterine artery ligation group, postoperative fever(6.5%),thrombosis(2.2%),hypomenorrhea(4.3%),pain(4.3%),hospitalization expenses 19138.5±12382.5 yuan,were significantly different, compared with those artery embolization group, which were 25.0%,21.4%,21.4%,28.6%,28960.5±13236.2 yuan, allP<0.05.There was no significant difference in 24-hour bleeding、the mean hospitalization time and Apgar score between the two groups(P>0.05).Conclusions:Tourniquet combined with uterine artery ligation plays a significant role in the operation of pernicious placenta previa with placenta accrete, which can significantly reduce the occurrence of intraoperative and postoperative complications and reduce the medical costs.