Konishi Yasutaka, Yamamoto Satoshi, Sugiki Kei, Sakamoto Hidetoshi, Sawamura Shigehito
From the *Department of Anesthesia, Teikyo University School of Medicine, Tokyo, Japan; and †Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle.
A A Case Rep. 2016 Sep 15;7(6):135-8. doi: 10.1213/XAA.0000000000000375.
Cesarean deliveries in patients with placenta accreta often are accompanied by life-threatening bleeding and sometimes death. A novel, multidisciplinary approach that uses uterine embolization after cesarean delivery recently has been advocated; however, embolization in the radiology department requires transfer of postoperative patients, which could increase maternal mortality and morbidity. In a case of severe placenta accreta, we planned a stepwise treatment, including cesarean delivery without separation of the placenta followed by intraoperative uterine arterial embolization in a hybrid operating room, followed by hysterectomy a few weeks after cesarean delivery. With no postpartum bleeding, complete hysterectomy was performed uneventfully 25 days later.
患有胎盘植入的患者进行剖宫产时常常伴有危及生命的出血，有时甚至会导致死亡。最近有人提倡一种新型的多学科方法，即在剖宫产术后使用子宫栓塞术；然而，在放射科进行栓塞需要术后患者转移，这可能会增加孕产妇的死亡率和发病率。在一例严重胎盘植入的病例中，我们计划了一种分步治疗方法，包括剖宫产时不分离胎盘，随后在杂交手术室进行术中子宫动脉栓塞，然后在剖宫产术后几周进行子宫切除术。由于产后无出血，25天后顺利进行了全子宫切除术。
