凶险性前置胎盘并胎盘植入剖宫产不同术式疗效分析
|
摘要
目的探讨剖宫产不同术式治疗凶险性前置胎盘(pernicious placenta previa, PPP)并胎盘植入的疗效和安全性。方法 PPP并胎盘植入患者48例,剖宫产术中行子宫下段双切口剖宫产联合子宫血管缝扎术及多重宫颈环状缝扎术者30例为观察组,剖宫产术中行低位腹主动脉球囊阻断术者18例为对照组。观察2组术后住院时间、术中出血量、术中输血量、产褥感染率、新生儿Apgar评分、新生儿体质量、子宫切除率、子宫复旧率等情况。结果 2组均成功保留子宫,术后42 d复查子宫均正常复旧;观察组住院时间[(7.51±1.06)d]、产褥感染率(3.3%)低于对照组[(8.17±0.93)d、27.8%](P<0.05),术中出血量[(1 396.66±635.05)mL]、红细胞、血浆及冷沉淀输入量[(5.55±0.92)u、(575.00±63.18)mL、(1.11±0.26)u]、新生儿体质量[(3 051.26±212.15)g]、Apgar评分[(9.56±0.25)分]与对照组[(1 382.16±416.62)mL、(5.42±0.55)u、(569.35±71.07)mL、(1.07±0.18)u、(3 018.06±242.02)g、(9.44±0.32)分]比较差异均无统计学意义(P>0.05)。结论子宫双切口剖宫产联合子宫血管缝扎术及宫颈多重环状缝扎术应用于PPP并胎盘植入患者安全、可行,术后住院时间短、产褥感染率低。
Objective To investigate the outcome and security of different cesarean section procedures in treating pernicious placenta previa(PPP) complicated with placenta percreta. Methods In 48 patients with PPP complicated with placenta percreta, 30 patients received double incision cesarean section of the uterus combined with uterine vascular suture and cervicular suture(observation group) and 18 patients received temporary occlusion of abdominal aorta with balloon in cesarean sections(control group). The postoperative hospital stay, intraoperative blood loss, intraoperative blood transfusion volume, puerperal infection rate, neonatal Apgar score, neonatal body mass, rate of hysterectomy and rate of uterus involution were compared between two groups. Results All uteri were successfully preserved and were normal 42 days after operation. The length of postoperative hospital stay((7.51±1.06) d) was shorter, and the puerperal infection rate was lower(3.3%) in observation group than that in control group((8.17±0.93) d, 27.8%)(P<0.05). There were no significant differences in the intraoperative blood loss((1 396.66±635.05) mL vs.(1 382.16±416.62) mL), intraoperative transfusion volumes of red blood cells((5.55±0.92) u vs.(5.42±0.55) u), plasma((575.00±63.18) mL vs.(569.35±71.07) mL) and cryoprecipitation((1.11±0.26) u vs.(1.07±0.18) u), neonatal body mass((3 051.26±212.15) g vs.(3 018.06±242.02) g) and neonatal Apgar score(9.56±0.25 vs. 9.44±0.32) between observation group and control group(P>0.05). Conclusion Double incision cesarean section of the uterus combined with uterine vascular suture and cervicular suture is safe and feasible for PPP complicated with placenta percreta, with shorter hospital stay and lower puerperal infection rate compared with temporary occlusion of abdominal aorta with balloon.
Objective To investigate the outcome and security of different cesarean section procedures in treating pernicious placenta previa(PPP) complicated with placenta percreta. Methods In 48 patients with PPP complicated with placenta percreta, 30 patients received double incision cesarean section of the uterus combined with uterine vascular suture and cervicular suture(observation group) and 18 patients received temporary occlusion of abdominal aorta with balloon in cesarean sections(control group). The postoperative hospital stay, intraoperative blood loss, intraoperative blood transfusion volume, puerperal infection rate, neonatal Apgar score, neonatal body mass, rate of hysterectomy and rate of uterus involution were compared between two groups. Results All uteri were successfully preserved and were normal 42 days after operation. The length of postoperative hospital stay((7.51±1.06) d) was shorter, and the puerperal infection rate was lower(3.3%) in observation group than that in control group((8.17±0.93) d, 27.8%)(P<0.05). There were no significant differences in the intraoperative blood loss((1 396.66±635.05) mL vs.(1 382.16±416.62) mL), intraoperative transfusion volumes of red blood cells((5.55±0.92) u vs.(5.42±0.55) u), plasma((575.00±63.18) mL vs.(569.35±71.07) mL) and cryoprecipitation((1.11±0.26) u vs.(1.07±0.18) u), neonatal body mass((3 051.26±212.15) g vs.(3 018.06±242.02) g) and neonatal Apgar score(9.56±0.25 vs. 9.44±0.32) between observation group and control group(P>0.05). Conclusion Double incision cesarean section of the uterus combined with uterine vascular suture and cervicular suture is safe and feasible for PPP complicated with placenta percreta, with shorter hospital stay and lower puerperal infection rate compared with temporary occlusion of abdominal aorta with balloon.
引文
[1] 张婷婷,吴晓玲,李小鹏,等.凶险型前置胎盘的诊治进展[J].中国妇幼健康研究,2015,26(4):902-905.
[2] 罗美好,叶萍,张璠.子宫下段环扎术治疗凶险性前置胎盘剖宫产术后出血的效果[J].中国当代医药,2015,22(19):116-118.
[3] 罗穗豫,李睿,梁菲,等.凶险性前置胎盘32例临床分析[J].中华实用诊断与治疗杂志,2014,27(6):568-569.
[4] 操冬梅,肖梅,管平,等.湖北省妇幼保健院近5年剖宫产率及剖宫产指征的变化分析[J].华中科技大学学报(医学版),2014,43(4):463-466.
[5] JSGIELSKA I,KAZDEPKA Z,TYLOCH M,et al.Clinical study of perinatal hysterectomy between 2000-2011 in the clinic of obstetrics,gynecological diseases and oncological gynecology in Bydgoszcz[J].Ginekol Pol,2014,85(3):192-194.
[6] 陈敦金,杨慧霞.胎盘植入诊治指南(2015)[J].中华围产医学杂志,2015,18(7):481-485.
[7] 崔世红,职云晓,张凯,等.腹主动脉球囊阻断术在中央型前置胎盘伴胎盘植入孕妇剖宫产术中的应用[J].中华妇产科杂志,2016,51(9):672-676.
[8] 赵先兰,杜莹莹,杨慧霞,等.腹主动脉球囊阻断下子宫修复成形术在凶险性前置胎盘合并穿透性胎盘植入的治疗作用[J].中华围产医学杂志,2017,20(9):644-648.
[9] 闫珺,武海英,胡文茄,等.超声引导下的腹主动脉球囊阻断术在凶险性前置胎盘并胎盘植入剖宫产术中的应用价值[J].中华实用诊断与治疗杂志,2018,32(11):1115-1117.
[2] 罗美好,叶萍,张璠.子宫下段环扎术治疗凶险性前置胎盘剖宫产术后出血的效果[J].中国当代医药,2015,22(19):116-118.
[3] 罗穗豫,李睿,梁菲,等.凶险性前置胎盘32例临床分析[J].中华实用诊断与治疗杂志,2014,27(6):568-569.
[4] 操冬梅,肖梅,管平,等.湖北省妇幼保健院近5年剖宫产率及剖宫产指征的变化分析[J].华中科技大学学报(医学版),2014,43(4):463-466.
[5] JSGIELSKA I,KAZDEPKA Z,TYLOCH M,et al.Clinical study of perinatal hysterectomy between 2000-2011 in the clinic of obstetrics,gynecological diseases and oncological gynecology in Bydgoszcz[J].Ginekol Pol,2014,85(3):192-194.
[6] 陈敦金,杨慧霞.胎盘植入诊治指南(2015)[J].中华围产医学杂志,2015,18(7):481-485.
[7] 崔世红,职云晓,张凯,等.腹主动脉球囊阻断术在中央型前置胎盘伴胎盘植入孕妇剖宫产术中的应用[J].中华妇产科杂志,2016,51(9):672-676.
[8] 赵先兰,杜莹莹,杨慧霞,等.腹主动脉球囊阻断下子宫修复成形术在凶险性前置胎盘合并穿透性胎盘植入的治疗作用[J].中华围产医学杂志,2017,20(9):644-648.
[9] 闫珺,武海英,胡文茄,等.超声引导下的腹主动脉球囊阻断术在凶险性前置胎盘并胎盘植入剖宫产术中的应用价值[J].中华实用诊断与治疗杂志,2018,32(11):1115-1117.