Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of South Florida School of Medicine, Tampa, FL, USA.
Am J Obstet Gynecol. 2010 Jun;202(6):628.e1-5. doi: 10.1016/j.ajog.2010.03.021.
The purpose of this study was to report the morbidity of nonemergent hysterectomy for suspected placenta accreta.
This was a retrospective study of all patients who underwent nonemergent hysterectomy for placenta accreta at Tampa General Hospital from June 1, 2003 to May 31, 2009.
Twenty-nine patients were identified. Diagnosis was suspected on ultrasound scanning in 26 women (6 women also underwent magnetic resonance imaging) and on direct vision at repeat cesarean section delivery in 3 women. All of the women were multiparous, and 18 women had undergone > or =2 cesarean section deliveries. Twenty-one women had a placenta previa, and 8 women had a low anterior placenta. Final pathologic findings revealed accreta (20 specimens), increta (6 women), and percreta (3 women). Mean total operative time was 216 minutes; blood loss was 4061 mL. Two women had ureteral transection (1 was bilateral); 3 women had cystotomy, and 3 women had partial cystectomy. Postoperative hemorrhage occurred in 5 women; 1 hemorrhage resolved after catheter embolization, and the other 4 hemorrhage required reoperation.
Nonemergent hysterectomy for placenta accreta is associated with significant morbidity in the forms of hemorrhage and urinary tract insult.
本研究旨在报告疑似胎盘植入的非紧急性子宫切除术的发病率。
这是一项回顾性研究，纳入了 2003 年 6 月 1 日至 2009 年 5 月 31 日期间在坦帕总医院因胎盘植入而行非紧急性子宫切除术的所有患者。
共确定了 29 例患者。26 例患者通过超声扫描（6 例患者还进行了磁共振成像）、3 例患者通过再次剖宫产时直接观察诊断为胎盘植入。所有患者均为多产妇，18 例患者行≥2 次剖宫产。21 例患者有前置胎盘，8 例患者有低置胎盘。最终病理检查结果显示为粘连（20 例标本）、植入（6 例）和穿透性胎盘植入（3 例）。平均总手术时间为 216 分钟；失血量为 4061mL。2 例患者发生输尿管横断（1 例为双侧）；3 例患者发生膀胱切开术，3 例患者行部分膀胱切除术。5 例患者术后发生出血；1 例出血经导管栓塞后缓解，其余 4 例出血需再次手术。
胎盘植入的非紧急性子宫切除术可导致严重的出血和泌尿道损伤等并发症。
