双侧股动脉预置管联合剖宫产治疗凶险型前置胎盘的临床研究

目的探讨双侧股动脉预置管联合剖宫产即刻动脉栓塞治疗凶险型前置胎盘合并胎盘植入的临床效果。方法对9例凶险型前置胎盘合并胎盘植入的患者,在无射线透视下行双侧股动脉置管,继而行剖宫产,取出胎儿后如证实胎盘植入子宫肌层,立即行动脉栓塞,栓塞成功后,钝锐性结合再行胎盘剥离,术后辅以甲氨蝶呤(Methotrexate,MTX)治疗。同时随访B超及血B-人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)水平。结果 9例患者皆栓塞成功,在确保产妇生命安全的前提下,均成功保全子宫。术后检查血B-HCG恢复正常,子宫B超未见异常。9例患者均恢复正常月经来潮。结论双侧股动脉预置管联合剖宫产即刻动脉栓塞治疗为凶险型前置胎盘合并胎盘植入患者最大限度的减少出血并保全子宫提供了一种安全的新选择。

Clinical study on the effect of double femoral artery catheterization combined with cesarean section in the treatment for dangerous type of placenta previa

Objective To discuss the clinical effect of double femoral artery catheterization combined with cesarean section in the treatment for dangerous type of placenta previa. Methods Nine pregnancy women who had been diagnosed with dangerous type of placenta previa and placenta implantation were selected to have firstly the femoral artery catheterization under X - ray followed by cesarean section. If placenta implantation was actually proved in the surgery, artery embolism would be undertaken, and secondly we manually removed the placenta. Post -operation Methotrexate（MTX） was the supplementary method in treatment and it would be important to follow up with B - ultrasound and for their human chorionic gonadotrophin （HCG） levels. Results Nine patients who had been undertaken the surgery were successfully cured without removing the uterus on the basement of keeping life safe. Not only HCG levels dropped to normal ,but also the follow - up of B - ultrasound returned back to normal. The menstrual cycle of nine cases finally recovered. Conclusion The double femoral artery catheterization combined with cesarean section provides a better option in reducing the risk of the removal of uterus and the blood - loss of the pregnancy women who are diagnosed with dangerous type of placenta previa and placenta implantation.