Department of Obstetrics and Gynecology, School of Medicine, Gaziantep University, Gaziantep, Turkey.
J Matern Fetal Neonatal Med. 2020 Jul;33(14):2441-2444. doi: 10.1080/14767058.2018.1554043. Epub 2019 Jan 6.
This study described a new technique to minimize the bleeding resulted from aberrant engorged vessels and unintended bladder injury in cases with abnormally invaded placenta adjacent to posterior bladder wall at cesarean hysterectomy. After filling the bladder with 300 ml saline aberrant engorged vessels were identified and skeletonized between lower uterine segment and bladder with blunt dissection by index finger down to the distal end point of cervix. This technique has beneficial effect on preventing bladder injury and reduces bleeding resulting from the aberrant vessels and the communicating vessels that were based around the vesicouterine fold and the cervico-vesical interface (in the lower part of the cervix); respectively. Our procedure may have some benefits including shorter operation time, lower amount of hemorrhage, and less bladder injury where anatomical landmarks are unclear, especially in abnormally invasive placentation adjacent to posterior bladder wall at cesarean hysterectomy.
本研究描述了一种新的技术，以最小化剖宫产子宫切除术时异常侵犯至膀胱后壁的胎盘附近出现的异常充血血管和意外膀胱损伤导致的出血。在膀胱充盈 300ml 生理盐水后，通过食指钝性分离至宫颈远端，在下段子宫和膀胱之间识别并游离异常充血的血管。该技术有利于防止膀胱损伤，并减少因血管异常和沟通血管引起的出血，这些血管位于膀胱子宫褶皱和宫颈-膀胱交界处（宫颈下部）周围。我们的手术程序可能具有一些优势，包括手术时间更短、出血量更少、在解剖标志不清晰的情况下（特别是在剖宫产子宫切除术时异常侵犯至膀胱后壁的胎盘附近），膀胱损伤更少。
