Mitric Cristina, Desilets Jade, Balayla Jacques, Ziegler Cleve
Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC.
Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montréal, QC.
J Obstet Gynaecol Can. 2019 Nov;41(11):1551-1557. doi: 10.1016/j.jogc.2019.01.016. Epub 2019 Apr 2.
The incidence of placenta accreta spectrum (PAS) has risen over the past decades, primarily in response to increasing Caesarean section rates. The surgical management of PAS is associated with significant morbidity, including hemorrhage and intensive care unit (ICU) admission. This study sought to evaluate the surgical outcomes of a PAS operative approach.
A single-centre retrospective chart review of all Caesarean hysterectomies for PAS by an assigned surgeon over a 16-year period was performed. Surgical outcomes were described (Canadian Task Force Classification II-2).
The described surgical approach involves a midline skin incision, high midline hysterotomy, a rapid single-layer uterine closure with no placental removal attempt, constant cephalad uterine traction, and liberal choice of subtotal hysterectomy. A total of 47 patients were included: 19 (40.4%) with placenta accreta, 14 (29.8%) with placenta increta, and 14 (29.8%) with placenta percreta. Mean estimated blood loss was 1416 ± 699 mL, and mean operative time was 112 ± 49 minutes. Overall, 16 patients (34.0%) required blood transfusion, and 4 patients (8.5%) required ICU admission. The average hospitalization was 5.2 days, with no re-admission within 30 days. The use of internal iliac balloons did not result in a difference in blood loss or operative time (P > 0.05). Patients with placenta percreta had significantly more blood loss (P = 0.02) and longer operative time (P = 0.007) compared with those with placenta accreta and increta.
The current surgical model for planned Caesarean hysterectomy for PAS exhibits a low complication rate. Further research is needed for developing a standardized approach to the management of PAS.
在过去几十年中，胎盘植入谱系疾病（PAS）的发病率有所上升，这主要是由于剖宫产率的增加。PAS的手术管理与显著的发病率相关，包括出血和入住重症监护病房（ICU）。本研究旨在评估一种PAS手术方法的手术效果。
对一名指定外科医生在16年期间进行的所有因PAS行剖宫产子宫切除术的病例进行单中心回顾性病历审查。描述了手术结果（加拿大工作组分类II-2）。
所描述的手术方法包括中线皮肤切口、高位中线子宫切开术、不试图切除胎盘的快速单层子宫闭合术、持续的子宫头侧牵引以及广泛选择次全子宫切除术。共纳入47例患者：19例（40.4%）为胎盘粘连，14例（29.8%）为胎盘植入，14例（29.8%）为穿透性胎盘植入。平均估计失血量为1416±699毫升，平均手术时间为112±49分钟。总体而言，16例患者（34.0%）需要输血，4例患者（8.5%）需要入住ICU。平均住院时间为5.2天，30天内无再次入院情况。使用髂内球囊在失血量或手术时间方面没有差异（P>0.05）。与胎盘粘连和胎盘植入患者相比，穿透性胎盘植入患者的失血量显著更多（P=0.02），手术时间更长（P=0.007）。
目前用于计划性剖宫产子宫切除术治疗PAS的手术模式并发症发生率较低。需要进一步研究以制定PAS管理的标准化方法。
