球囊临时阻断技术在凶险性前置胎盘剖宫产术中的应用

目的 比较不同球囊阻断技术用于凶险性前置胎盘剖宫产术中的安全性、有效性.方法 回顾性分析2014年3月至2016年4月施行剖宫产术的15例凶险性前置胎盘患者.为减少术中出血并尽可能保留子宫,其中7例接受腹主动脉球囊临时阻断术(A组),8例接受双侧髂内动脉球囊临时阻断术(B组).记录并比较两组患者介入术中辐射剂量,剖宫产术中出血量、输血量、子宫切除率,术后住院时间及介入相关并发症.结果 15例患者均为中央型前置胎盘伴胎盘植入广泛,在球囊临时阻断辅助下均顺利实施剖宫产手术.7例(A组4例,B组3例)作子宫次全切,两组各1例术后出现下肢动脉血栓栓塞.A组辐射剂量明显低于B组(P＜0.01),术中出血量、输血量、子宫切除率、产后住院时间及介入相关并发症发生率均低于B组,但病例数有限,差异无统计学意义(P＞0.05).结论 球囊阻断技术辅助剖宫产术是治疗凶险性前置胎盘的安全有效方法,腹主动脉球囊临时阻断术辐射剂量明显低于双侧髂内动脉球囊临时阻断术.

The application of temporary balloon occlusion technique in performing cesarean section for patients with pernicious placenta previa

Objective To compare the safety and effectiveness of temporary occlusion techniques with different balloons in performing cesarean section for patients with pernicious placenta previa.Methods The clinical data of 15 patients with pernicious placenta previa,who received cesarean section during the period from March 2014 to April 2016,were retrospectively analyzed.In order to reduce bleeding during operation and to preserve the uterus as far as possible,temporary occlusion of abdominal aorta with balloon was adopted in 7 patients (group A),and temporary balloon occlusion of bilateral internal iliac arteries was employed in 8 patients (group B).The intraoperative radiation dose,the amount of blood loss and blood transfusion during cesarean section,the hysterectomy rate,the postoperative hospitalization days,and the intervention-related complications were documented,and the results were compared between the two groups.Results All the 15 patients were suffered from central type of placenta praevia complicated by extensive placenta accreta.With the help of temporary balloon occlusion technique,the cesarean section was successfully accomplished in all 15 patients.Subtotal hysterectomy had to be done in 7 patients,including 4 patients of group A and 3 patients of group B,and every one patient from each group developed arterial thrombosis of lower limb.The intraoperative radiation dose of group A was significantly lower than that of group B (P＜0.01),besides the amount of blood loss and blood transfusion during cesarean section,the hysterectomy rate,the postoperative hospitalization days,and the intervention-related complications of group A were all lower than those of group B,but because of the limited number of cases these differences were not statistically significant (P＞0.05).Conclusion For the treatment of pernicious placenta previa,temporary balloon occlusion technique-assisted cesarean section is safe and effective.The intraoperative radiation dose in the group using temporary balloon occlusion of abdominal aorta is remarkably lower than that in the group using temporary balloon occlusion of bilateral internal iliac arteries.