Hospital das Clínicas, Interventional Radiology Unit, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP 05403-001, Brazil.
Cardiovasc Intervent Radiol. 2011 Aug;34(4):758-64. doi: 10.1007/s00270-011-0166-2. Epub 2011 May 20.
The purpose of this study was to describe the preliminary results of prophylactic temporary balloon occlusion of the internal iliac arteries for bleeding control in patients with placenta accreta during cesarean hysterectomy.
From May 2006 to March 2010, 21 patients diagnosed with placenta accreta using ultrasound and/or magnetic resonance imaging were submitted to prophylactic balloon occlusion before hysterectomy. Fluoroscopy, balloon occlusion time, surgical duration, intraoperative blood loss, transfusion volume, and procedure complications were analyzed.
The mean age was 30.5 years with a mean of 3.6 previous gestations. Imaging studies revealed that all patients had placenta accreta and all were submitted to cesarean hysterectomy. One hysterectomy was due to previous diagnosis of fetal death and another due to cesarean with uterine curettage. Mean fluoroscopy time was 7.5 min, balloon occlusion time was 164 min, and surgery duration was 260 min. Estimated blood loss was 1,671.5 ml with mean reposition fluids of 3,538 ml of crystalloids, 309.5 ml of colloids, and 1.24 ml of packed red blood cells. Two patients were submitted to thromboembolectomy due to prolonged surgical time. There was no maternal or fetal mortality related to the procedure.
The results demonstrated that prophylactic balloon occlusion of internal iliac artery is a safe method and appears to reduce blood loss and transfusion requirements in patients diagnosed with placenta accreta who undergo cesarean hysterectomy. Antenatal imaging diagnosis of placenta accreta enables preoperative planning.
本研究旨在描述在剖宫产子宫切除术中预防性暂时阻断髂内动脉以控制出血的初步结果，用于胎盘植入患者。
2006 年 5 月至 2010 年 3 月，21 例经超声和/或磁共振成像诊断为胎盘植入的患者在子宫切除术前接受预防性球囊阻断。分析透视、球囊阻断时间、手术时间、术中失血量、输血量和手术并发症。
患者平均年龄 30.5 岁，平均既往妊娠 3.6 次。影像学研究显示所有患者均有胎盘植入，均行剖宫产子宫切除术。1 例因胎儿死亡而进行子宫切除术，另 1 例因剖宫产伴刮宫术而进行子宫切除术。透视时间平均为 7.5 分钟，球囊阻断时间为 164 分钟，手术时间为 260 分钟。估计失血量为 1671.5ml，平均晶体液 3538ml，胶体液 309.5ml，浓缩红细胞 1.24ml。2 例因手术时间延长而行血栓切除术。无与该手术相关的产妇或胎儿死亡。
结果表明，预防性髂内动脉球囊阻断是一种安全的方法，似乎可减少胎盘植入患者行剖宫产子宫切除术时的失血量和输血需求。胎盘植入的产前影像学诊断可进行术前计划。
