Department of Obstetrics and Gynaecology, St George's Healthcare NHS Trust, London, UK.
Int J Gynaecol Obstet. 2012 May;117(2):191-4. doi: 10.1016/j.ijgo.2011.12.005. Epub 2012 Feb 11.
The reported maternal mortality for morbidly adherent placenta ranges from 7% to 10% worldwide. Current treatment modalities for this potentially life-threatening condition include radical approaches such as elective peripartum hysterectomy with or without bowel/bladder resection or ureteric re-implantation (for placenta percreta infiltrating these organs), and conservative measures such as compression sutures with balloon tamponade and the placenta remaining in situ. However, both conservative and radical measures are associated with significant maternal morbidity and mortality. The present article describes the Triple-P procedure-which involves perioperative placental localization and delivery of the fetus via transverse uterine incision above the upper border of the placenta; pelvic devascularization; and placental non-separation with myometrial excision and reconstruction of the uterine wall-as a safe and effective alternative to conservative management or peripartum hysterectomy.
全世界报道的凶险性前置胎盘的产妇死亡率为 7%至 10%。这种潜在危及生命的病症的当前治疗方法包括激进方法，如选择性剖宫产伴或不伴肠/膀胱切除或输尿管再植入（对于胎盘植入这些器官的胎盘植入），以及保守方法，如压迫缝合伴球囊填塞和胎盘原位保留。然而，保守和激进措施都与显著的产妇发病率和死亡率相关。本文描述了 Triple-P 手术——包括围手术期胎盘定位和通过横切口在胎盘上缘上方分娩胎儿；骨盆去血管化；以及不分离胎盘，切除子宫肌层并重建子宫壁——作为保守治疗或剖宫产的安全有效的替代方法。
