改良式髂总动脉球囊闭塞术在凶险型前置胎盘并胎盘植入手术中的临床研究

目的探讨改良式髂总动脉球囊闭塞术在凶险型前置胎盘并胎盘植入手术的可行性及安全性。方法回顾性分析2010年1月²014年5月我院34例凶险型前置胎盘并胎盘植入患者的资料,其中改良式髂总动脉球囊闭塞术下行剖宫产术14例为治疗组,20例不选择改良式髂总动脉球囊闭塞术行剖宫产术为对照组。比较两组的手术时间、术中出血量、输血量、产后出血、凝血功能障碍及子宫切除发生率,住院费用、住院时间。结果治疗组术中出血量(1976.92±1912.74)ml明显少于对照组(4965.00±3912.10)ml(t=-2.801,P=0.009),输血量(1735.71±1831.19)ml明显少于对照组(3832.50±2428.52)ml(t=-2.728,P=0.010),产后出血率(57.14%)明显低于对照组(90.00%)(χ2=8.816,P=0.006),住院费用(37917.77±13186.98)元明显多于对照组(22988.54±10161.63)元(t=3.730,P=0.001),手术时间、子宫切除率、凝血功能障碍发生率、住院时间差异均无统计学意义(P>0.05)。结论改良式髂总动脉球囊闭塞术在凶险型前置胎盘并胎盘植入手术中应用具有减少术中出血、术野暴露清晰、减少并发症等优点,对提高孕产妇抢救成功率、降低病死率,并争取保留子宫,提高产妇生存质量,减少家庭及社会负担,有较好的社会效益。是凶险型前置胎盘并植入手术很好的选择。

Use of modified arteriae iliaca communis bloom occlusion in hysterectomy for pernicious placenta previa with placenta implantation

Objective To investigate the clinical feasibility and safety of modified Arteria iliaca communis bloom occlusion in hysterectomy for pernicious placenta previa with placenta implantation surgery. Methods History records from thirty-four patients diagnosed with pernicious placenta previa complicated with placenta implantation in our institution from January 2010 to May 2014 were retrospectively analyzed. They were assigned into a bloom group （ n=14）, of which patients were given modified arteria iliaca cornmunis bloom occlusion in hysterectomy for pernicious placenta previa with placenta implantation, and another control group （ n =20） which patients received traditional hysterectomy without modified arteria iliaca communis bloom occlusion. The comparisons of operative duration, intra-operative bleeding volume, transfused blood volume, post -operative hemorrhage incidence, blood coagulation disorders incidence rate and womb excision incidence rate, hospitalized cost and hospitalized duration between the two groups were done. Results Compared to the con trol group, the bloom group had less intra-operative blood loss [（1976.92±1912. 74） ml vs. （4965.00 ±3912.10）ml, （ t =-2. 801, P =0. 009）], and the transfused blood volume（1735.71±1831.19）ml was obvious less than control group（3832. 504±2428.52）ml （ t = -2. 728, P =0. 010）, and the post-operative hemorrhage incidencerate（57.14%）was obvious less than control group （90.00%） （Х^2=8. 816, P =0. 006）, and the hospitalized costs（37917.77±13186.98）yuan was obvious more than control group（22988.54!10161.63）yuan （ t = 3. 730, P = 0. 001）. In comparison of operation duration, the uterus resection incidence, the incidence of blood coagulation dysfunction, hospitalized duration between the two groups, there were no statistical differences （all P 〈0.05）. Conclusion Compared with tradition surgery, modified Arteria iliaca communis bloom occlusion in hysterectomy for pernicious placenta previa with placenta impla