Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
Department of Obstetrics and Gynaecology, McGill University Health Centre, McGill University, Montreal, QC, Canada.
Int J Gynaecol Obstet. 2020 Oct;151(1):91-96. doi: 10.1002/ijgo.13256. Epub 2020 Jun 29.
To compare surgical outcomes between women undergoing prophylactic internal iliac artery ligation or preoperative placement of balloon-occlusive devices at cesarean hysterectomy for placenta accreta spectrum (PAS) disorders.
A retrospective cohort study was conducted at a tertiary-care referral center for PAS disorders in Ontario, Canada. Eligible electronic records were reviewed of women undergoing cesarean hysterectomy for PAS disorders between November 2012 and June 2018. Outcomes for the ligation and balloon groups were compared primarily on procedure-related complications and secondarily on total procedure time, bleeding and transfusion metrics, and intraoperative and postoperative complications.
Of the 79 cases of cesarean hysterectomy, 47 underwent balloon placement and 32 underwent ligation. Baseline characteristics between the groups were similar except for more emergency procedures in the ligation group (37.5% vs 12.8%, P=0.014). The balloon-related complication rate was 5/47 (10.6%), with no reported complications in the ligation group (P=0.077). Procedural time was longer in the balloon group (353 ± 14 vs 227 ± 13 minutes, P<0.001). Estimated blood loss was similar (1874 ± 245 mL vs 1713 ± 181 mL, P=0.590).
Women undergoing prophylactic placement of endovascular balloons at caesarean hysterectomy for PAS disorders had a 10.6% procedure-related complication rate and increased total procedure time, with no decrease in blood loss compared to those undergoing surgical ligation.
比较行预防性子宫动脉结扎术或术前放置球囊阻塞装置的妇女在胎盘植入谱系（PAS）疾病行剖宫产子宫切除术的手术结果。
在加拿大安大略省 PAS 疾病的三级转诊中心进行了一项回顾性队列研究。对 2012 年 11 月至 2018 年 6 月间行 PAS 疾病剖宫产子宫切除术的女性进行了合格的电子病历回顾。结扎组和球囊组的主要比较手术相关并发症，次要比较总手术时间、出血和输血指标以及术中术后并发症。
在 79 例剖宫产子宫切除术中，47 例行球囊放置，32 例行结扎。两组的基线特征相似，除了结扎组有更多的紧急手术（37.5%比 12.8%，P=0.014）。球囊相关并发症发生率为 5/47（10.6%），结扎组无报告并发症（P=0.077）。球囊组的手术时间较长（353±14 分钟比 227±13 分钟，P<0.001）。估计出血量相似（1874±245 毫升比 1713±181 毫升，P=0.590）。
在 PAS 疾病行剖宫产子宫切除术时预防性放置血管内球囊的女性手术相关并发症发生率为 10.6%，总手术时间延长，与行外科结扎术相比，出血量无减少。
