Yin Yin, Qu Lin, Jin Bai, Yang Zhengqiang, Xia Jinguo, Sun Lizhou, Zhou Xin
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People's Republic of China.
Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University Hospital, Nanjing, People's Republic of China.
Int J Womens Health. 2022 Aug 25;14:1161-1171. doi: 10.2147/IJWH.S367654. eCollection 2022.
We aimed to investigate the combined effect of spiral suture of the lower uterine segment with intraoperative aortic balloon occlusion in morbidly adherent placenta previa cases.
This retrospective, single-center study involved patients from 2017 to 2020. The study considered 68 cases of morbidly adherent placenta previa cases from medical records retrospectively with age ranging from 23 to 42 years. Bilateral uterine artery embolization was performed, to control excessive bleeding. Perioperative blood loss, hysterectomy rate, amount of blood transfusion, balloon occlusion time, fetal and maternal radiation dose, and postpartum complications were assessed.
A total of 68 patients underwent surgery. Hysterectomy was performed in three patients and uterine artery embolization in 21 patients. Of 53 patients who required blood transfusions, the amount of packed red blood cells given was 800 mL and the amount of plasma given was 400 mL. Median abdominal aortic balloon occlusion time was 17 minutes. Fetal and maternal radiation doses were 5 mGy and 12 mGy, respectively. One patient experienced surgery-related complications, a bladder injury. No major catheterization-related and postpartum complications were observed.
Fertility-sparing surgery for women with morbidly adherent placenta could include abdominal aortic balloon occlusion and spiral suture of lower uterine segment.
我们旨在研究子宫下段螺旋缝合联合术中主动脉球囊阻断在凶险性前置胎盘中的综合效果。
这项回顾性单中心研究纳入了2017年至2020年的患者。该研究回顾性分析了病历中的68例凶险性前置胎盘病例，患者年龄在23岁至42岁之间。进行双侧子宫动脉栓塞以控制出血过多。评估围手术期失血量、子宫切除率、输血量、球囊阻断时间、胎儿和母体辐射剂量以及产后并发症。
共有68例患者接受手术。3例患者进行了子宫切除术，21例患者进行了子宫动脉栓塞。在53例需要输血的患者中，输注的浓缩红细胞量为800 mL，输注的血浆量为400 mL。腹主动脉球囊阻断的中位时间为17分钟。胎儿和母体的辐射剂量分别为5 mGy和12 mGy。1例患者出现手术相关并发症，即膀胱损伤。未观察到与导管插入相关的重大并发症和产后并发症。
对于凶险性前置胎盘的女性，保留生育功能的手术可包括腹主动脉球囊阻断和子宫下段螺旋缝合。
