摘要
目的探讨腹主动脉球囊阻断在凶险型前置胎盘(PPP)伴胎盘植入剖宫产术中的应用价值,分析技术重点及相关问题处理。方法对97例PPP伴胎盘植入产妇行球囊阻断腹主动脉辅助下剖宫产(观察组),同时对97例PPP伴胎盘植入产妇直接行剖宫产(对照组)。观察组剖宫产术前预置球囊导管于髂动脉分叉上方腹主动脉,胎儿头娩出后充盈球囊阻断腹主动脉,剥离胎盘并缝合剥离面止血,创面充分缝合仍出血行子宫动脉栓塞,栓塞后再出血则行子宫次全切除。记录观察组术中出血量、手术时间、子宫保留与否、胎儿X线辐射剂量、术后并发症等情况。结果观察组97例均成功预置腹主动脉球囊,辅助剖宫产完成分娩,保留子宫96例,次全切除1例;对照组97例中11例切除子宫。观察组、对照组平均出血量分别为(1 238.0±139.2)mL、(3 373.0±196.3)mL(P<0.001),手术时间分别为(70.6±3.6)min、(128.6±6.2)min(P<0.000 1)。观察组胎儿辐射剂量为(6.1±1.4)mGy;术后5例产妇发生髂股动脉血栓形成,溶栓后血栓消失,未出现肾功能损伤、血管破裂、下肢缺血等严重并发症。结论球囊阻断腹主动脉辅助PPP伴胎盘植入产妇剖宫产手术,可明显减少术中出血量,缩短手术时间,显著降低子宫切除风险。对术中胎儿辐射、球囊置放、动脉血栓等问题应有充分认识,严格控制适应证,尽量避免并发症发生并及时处理。
Objective To evaluate the application of temporal balloon occlusion of abdominal aorta in performing cesarean section for delivery women with pernicious placenta previa（PPP） complicated by placenta implantation, and to discuss its technical points and the management of related complications. Methods A total of 97 delivery women with PPP accompanied by placenta implantation received cesarean section with the help of balloon occlusion of abdominal aorta（observation group）, and other 97 delivery women with PPP accompanied by placenta implantation directly received cesarean section（control group）. For the patients of observation group, balloon catheter was preset in abdominal aorta above the bifurcation of the iliac artery before cesarean section, and the balloon was inflated to obstruct the abdominal aorta when the fetal head was delivered, then the placenta was peeled off and the peeling surface was sutured to stop bleeding. If the bleeding could not be stopped after the peeling surface was totally sutured, uterine artery embolization was carried out, and subtotal hysterectomy had to be employed when re-bleeding occurred after uterine artery embolization. The amount of intraoperative blood loss, the time spent for surgery, the reservation of uterus,the radiation dose received by fetus, the postoperative complications, etc. in the observation group were recorded. Results Balloon catheter was successfully preset in the abdominal aorta in all 97 delivery women of observation group, and with the help of balloon occlusion of abdominal aorta the cesarean section was accomplished. The uterus was reserved in 96 delivery women, and subtotal hysterectomy was performed in one delivery woman. Among the 97 delivery women of the control group, 11 received subtotal hysterectomy.In the observation group and control group, the average amount of intraoperative blood loss was（1 238.0±139.2） m L and（3 373.0±196.3） m L respectively（P〈0.001）, and the time spent for surgery was（70.6±3.6）min and（128.6±6
作者
张建好
韩新巍
赵先兰
王晓娟
周艳
李秀芳
刘慧娜
张梅
冯志鹏
李宗明
ZHANG Jianhao;HAN Xinwei;ZHAO Xianlan;WANG Xiaojuan;ZHOU Yan;LI Xiufang;LIU Huina;ZHANG Mei;FENG Zhipeng;LI Zongming(Department of lnterventional Radiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan Province 450052,China)
出处
《介入放射学杂志》
CSCD
北大核心
2018年第8期725-729,共5页
Journal of Interventional Radiology
基金
河南省医学科技攻关计划项目(201503021)
关键词
球囊阻断腹主动脉
前置胎盘
胎盘植入
出血量
手术时间
胎儿辐射
动脉血栓形成
balloon occlusion of abdominal aorta
placenla previa
placenla implantation
amounl of blood loss
time spenl for operation
fetal radiation
arterial thrombosis
