腹主动脉预置球囊辅助前置胎盘伴胎盘植入剖宫产临床应用

目的 探讨腹主动脉预置球囊辅助前置胎盘伴胎盘植入剖宫产的临床应用价值.方法 对72例前置胎盘伴胎盘植入产妇腹主动脉预置球囊辅助剖宫产,其中33例为凶险性前置胎盘(A型),36例为瘢痕子宫、前置胎盘伴胎盘植入(B型),3例为无剖宫产史前置胎盘伴胎盘植入(C型).记录剖宫产术中出血量、子宫切除情况、球囊预置术中X线辐射量及介入操作相关并发症.结果 剖宫产术中A型、B型、C型产妇平均出血量分别为1 461 ml、947 ml、533 ml;9例子宫大部切除,32例子宫修补;2015年17例、2016年55例球囊预置术中平均X线辐射量分别为(28.5±14.1) mGy、(3.7±2.5) mGy;住院期间发生右股浅动脉血栓1例,右下肢静脉血栓1例,皮下血肿2例.结论 腹主动脉球囊预置辅助前置胎盘伴胎盘植入产妇剖宫产,可有效减少术中出血量,明显降低子宫切除率;手术操作简便,X线辐射时间短;熟练操作,能进一步减少介入操作相关并发症.

Clinical application of preset balloon in abdominal aorta in assisting cesarean section for patients with placenta previa complicated by placenta accreta

Objective To investigate the clinical value of preset balloon in abdominal aorta in assisting cesarean section for patients with placenta previa complicated by placenta accreta.Methods Preset balloon in abdominal aorta was performed in 72 patients with placenta previa complicated by placenta accreta before cesarean section was carried out.Of the 72 patients,pernicious placenta previa (type A) was seen in 33,scar uterus,placenta previa with placenta accreta (type B) in 36 patients,and placenta previa complicated by placenta accreta with no cesarean section history (type C) in 3.The amount of blood loss during cesarean section,the course of uterine resection,the X-ray radiation dose in performing placement of balloon,and the procedure-related complications were recorded.Results The average amount of intraoperative blood loss in type A,B and C group was 1461 ml,947 ml and 533 ml,respectively.Subtotal hysterectomy was adopted in 9 patients and uterine repair in 32 patients.The average radiation doses in 17 patients who received preset balloon procedure in 2015 and in 55 patients who received preset balloon procedure in 2016 were (28.5±14.1) mGy and (3.7±2.5) mGy,respectively.During hospitalization period,one patient developed right superficial femoral artery thrombosis,one patient developed venous thrombosis of right lower extremity,and subcutaneous hematoma occurred in two patients.Conclusion Temporary occlusion of the abdominal aorta with preset balloon to assist the cesarean section for patients with placenta previa complicated by placenta accreta can effectively reduce the amount of intraoperative blood loss and markedly reduce hysterectomy rate.The procedure of preset balloon is simple,and the X-ray exposure time is short.Skilled and experienced manipulation can further reduce the incidence of complications.