摘要
目的应用球囊导管阻断腹主动脉后再行胎盘的剥离,探讨其对减少凶险性前置胎盘并胎盘植入的剖宫产术中出血的临床意义。方法回顾性分析22例凶险性前置胎盘并胎盘植入的剖宫产患者。所有患者均接受术前放置球囊导管,凶险性前置胎盘剖宫产术中先娩出胎儿,断脐后立即给予球囊阻断。结果所有患者均证实为凶险性前置胎盘并胎盘植入,包括3例穿透性胎盘植入患者。该方法的技术成功率为86.3%(19/22)。19例患者成功接受手术并保留子宫。子宫切除率约13.7%(3/22)。术中出血量为(686±355)ml。22例患者中仅3例穿透性胎盘植入的患者术中输血,其余19例患者均未输血,术中球囊阻断时间以及胎儿的辐射剂量分别为(25.4±7.2)min和(30.2±8.9)m Gy。术后和随访期间并无介入相关的并发症。结论腹主动脉球囊阻断术能够有效控制凶险性前置胎盘并胎盘植入患者胎盘剥离时引起的术中大出血,降低输血需求及子宫切除率。
Objective To discuss the application of abdominal aorta occlusion with balloon catheter combined with subsequent placental detachment in order to reduce blood loss in caesarean section for dangerous placenta previa associated with placenta accrete. Methods The clinical data of 22 patients with dangerous placenta previa associated with placenta accrete, who received caesarean section, were retrospectively analyzed. Placement of balloon catheter in abdominal aorta was performed in all patients before the operation. During caesarean section for dangerous placenta previa, fetal delivery was first accomplished and abdominal aorta occlusion with balloon was carried out immediately after the umbilical cord was cut off. Results The diagnosis of dangerous placenta previa associated with placenta accrete was confirmed in all patients, including 3 patients who had placenta percreta. The technical success rate of this treatment was 86.3% （19/22）. Nineteen patients successfully underwent caesarean section while the uterus was retained. Hysterectomy rate was about 13.7% （3/22）. The amount of blood loss during operation was （686＋355） ml. Among the 22 patients, only 3 patients with placenta percreta needed intraoperative blood transfusion, while blood transfusion was not needed in the remaining 19 patients. The intraoperative balloon occlusion time and fetal radiation dose were （25.4±7.2） minutes and （30. 2 ± 8.9） mGy respectively. No intervention-related complications occurred after the procedure and during the follow-up period. Conclusion Abdominal aorta occlusion with balloon can effectively control the intraoperative hemorrhage during placental dissection in patients with dangerous placenta previa associated with placenta accrete, it can also reduce the need of transfusion and decrease the hysterectomy rate.
出处
《介入放射学杂志》
CSCD
北大核心
2016年第7期624-627,共4页
Journal of Interventional Radiology
关键词
腹主动脉阻断
球囊导管
凶险性前置胎盘
胎盘植入
abdominal aorta occlusion
balloon catheter
dangerous placenta previa
placenta accrete
