[髂内动脉球囊阻断术在凶险性前置胎盘中的应用]
[The Application of Internal Iliac Artery Balloon Occlusion in Pernicious Placenta Previa].
作者信息
Qi Xiao-Rong, Liu Xing-Hui, You Yong, Wang Xiao-Dong, Zhou Rong, Xing Ai-Yun, Zhang Li, Ning Gang, Zhao Fu-Min, Li Kai-Ming
机构信息
Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu 610041, China.
出版信息
Sichuan Da Xue Xue Bao Yi Xue Ban. 2016 Jul;47(4):618-623.
OBJECTIVES
To evaluate the clinical application value of internal iliac artery balloon occlusion in pernicious placenta previa.
METHODS
We retrospectively reviewed the medical records of the patients of pernicious placenta previa in a single center from Jan, 2010 to Jan, 2015. The patients were divided into two groups, internal iliac artery balloon occlusion group and the control group without endovascular intervention. Blood loss in operation, volume of transfused blood products, caesarean hysterectomy, operating time, hospital days after operation and postoperative morbidity were compared between the two groups.
RESULTS
The balloon occlusion group had significantly less blood loss, the volume of transfused blood products, caesarean hysterectomy, hospital day after operation than the control group had. There was no statistical difference in operating time, intensive care units (ICU), hypotension, infection, hypoxemia, bladder injury, bowel obstruction, neonatal asphyxia between the two groups. The balloon occlusion group had significantly higher rate in coagulopathy, hypoalbuminemia, electrolyte imbalance. Among the patients whose uterus were preserved, the blood loss was not significantly difference between the two groups. Among the patients with the complication of placenta accreta, caesarean hysterectomy was less in balloon group, and blood loss between the two groups was not significantly different. Among the patients without placenta accrete, the blood loss was less in balloon group, and caesarean hysterectomy between the two groups was not significantly different. The risk of hysterectomy in balloon group was related to placenta accreta, uterine arteries engorgement, placental invasive serosa, taking placenta by hand, placental invasive bladder, barrel-shaped thickening of lower uterine segment, unable to remove placenta.
CONCLUSIONS
Internal iliac artery balloon occlusion is an effective treatment for pernicious placenta previa.
目的
评估髂内动脉球囊阻断术在凶险性前置胎盘中的临床应用价值。
方法
回顾性分析2010年1月至2015年1月某单中心凶险性前置胎盘患者的病历资料。将患者分为两组，即髂内动脉球囊阻断组和未进行血管内介入治疗的对照组。比较两组患者的术中出血量、输血量、剖宫产子宫切除术、手术时间、术后住院天数及术后并发症。
结果
球囊阻断组的术中出血量、输血量、剖宫产子宫切除术、术后住院天数均显著少于对照组。两组在手术时间、重症监护病房（ICU）、低血压、感染、低氧血症、膀胱损伤、肠梗阻、新生儿窒息方面无统计学差异。球囊阻断组的凝血病、低白蛋白血症、电解质紊乱发生率显著更高。在保留子宫的患者中，两组间出血量无显著差异。在胎盘植入并发症患者中，球囊组的剖宫产子宫切除术较少，两组间出血量无显著差异。在无胎盘植入的患者中，球囊组的出血量较少，两组间剖宫产子宫切除术无显著差异。球囊组子宫切除术的风险与胎盘植入、子宫动脉充血、胎盘侵犯浆膜、徒手取胎盘、胎盘侵犯膀胱、子宫下段桶状增厚、无法取出胎盘有关。
结论
髂内动脉球囊阻断术是治疗凶险性前置胎盘的有效方法。
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