Royal North Shore Hospital, St. Leonards, NSW, Australia.
Am J Obstet Gynecol. 2010 Jan;202(1):38.e1-9. doi: 10.1016/j.ajog.2009.08.037. Epub 2009 Nov 17.
The purpose of this study was to describe the use of a staged procedure that involved femoral artery catheterization, classic cesarean section delivery, and uterine and placental embolization before hysterectomy for placenta accreta.
We conducted a cohort study of retrospective and prospective data from cases of histologically identified placenta accreta at a tertiary teaching hospital with access to interventional radiology.
Twenty-six cases of placenta accreta were identified histologically (7 accretas, 5 incretas, and 14 percretas); 8 cases were successful staged embolization procedures. These cases had significant reductions in blood loss (553 vs 4517 mL; P = .0001), need for transfusion (2 vs 16; P = .001), and units of blood transfused (0.5 vs 7.9; P = .0013). The total operation time was no different between the 2 groups, but there was a longer length of anesthesia (2.7 vs 6.6 hours; P = .0001). There were nonsignificant reductions in admission to the intensive care unit and length of hospital stay.
We found that the successful use of a staged embolization hysterectomy procedure for placenta accreta is associated with decreased maternal morbidity.
本研究旨在描述一种分阶段的手术方法，即在胎盘植入症患者行子宫切除术之前，先进行股动脉导管插入术、经典剖宫产术分娩，然后进行子宫和胎盘栓塞。
我们对一家三级教学医院的介入放射学治疗的胎盘植入症病例进行了回顾性和前瞻性队列研究。
组织学上共确定了 26 例胎盘植入症（7 例粘连性胎盘、5 例植入性胎盘和 14 例穿透性胎盘）；8 例成功进行了分期栓塞术。这些病例的出血量（553 与 4517 毫升；P =.0001）、输血需求（2 与 16；P =.001）和输血量（0.5 与 7.9；P =.0013）均显著减少。两组的总手术时间无差异，但麻醉时间更长（2.7 与 6.6 小时；P =.0001）。入住重症监护病房和住院时间的减少没有统计学意义。
我们发现，成功应用分期栓塞子宫切除术治疗胎盘植入症可降低产妇发病率。
