腹主动脉球囊阻断术联合子宫动脉栓塞术对凶险性前置胎盘的治疗效果
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摘要
目的探讨腹主动脉球囊阻断术联合子宫动脉栓塞术对凶险性前置胎盘的临床疗效。方法选取2012年4月～2015年11月于我院就诊的69例凶险性前置胎盘伴植入患者作为研究对象,所有患者终止妊娠方法均为剖宫产手术。根据介入方法不同分为对照组(n=45例)和研究组(n=24例),其中对照组采用术后子宫动脉栓塞术,研究组采用术前腹主动脉球囊阻断术联合术后子宫动脉栓塞术。对比两组胎盘植入术中情况、术中输血量、出血量、手术时间、住院时间、子宫切除率、新生儿Apgar 1、5min评分、新生儿出生体重和并发症发生情况。结果两组胎盘植入术中所见类型如:穿透膀胱后壁、植入膀胱后壁、穿透肌层植入、部分肌层植入等比较差异无统计学意义(P>0.05)。研究组术中输血量、术中出血量及手术时间均明显低于对照组(P<0.05)。研究组住院时间明显短于对照组,子宫切除率明显低于对照组(P<0.05)。两组Apgar评分比较差异无统计学意义(t=1.774,P>0.05)。两组Apgar评分比较差异无统计学意义(t=1.502,P>0.05)。两组新生儿体重比较差异无统计学意义(t=1.356,P>0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。结论腹主动脉球囊阻断术联合子宫动脉栓塞术较单纯子宫动脉栓塞术有较低的子宫切除率,减少输血量及出血量,缩短手术时间和住院时间,可改善临床结局。
Objective To research the clinical efficacy of abdominal aortic balloon blockage combined with uterine artery embolization in the treatment of pernicious placenta previa.Methods 69 pernicious placenta previa patients between April 2012 and November 2015 of our hospital were selected.All of them were taken Cesarean section operation,and divided them into control group and research group by different intervention methods.The control group was treated by uterine artery embolization,while the research group was treated by abdominal aortic balloon blockage combined with uterine artery embolization.The condition of placental implantation,intraoperative transfusion,bleeding volume,operation duration,long of stay,hysterectomy rate,Apgar score of 1 minute and 5 minutes after birth,newborn birth weight and complications of two groups were observed.Results The condition of placental implantation,such as types of penetrates the posterior wall of the bladder,implant the posterior wall of the bladder,penetrating the muscular layer,partial myolayer implantation of two groups had no statistical difference(P>0.05).The intraoperative transfusion,bleeding volume and operation duration of research group were much lower than that of control group(P<0.05).The long of stay and the hysterectomy rate of research group were much lower than that of control group(P<0.05).The Apgar 1 min score of research group and the hysterectomy rate were 8.43±0.91 and 8.83±0.94(P>0.05).The Apgar 5 min score of research group and control group were 9.58±0.64 and9.64±0.61(P>0.05).The newborn birth weight of research group and control group were 2.63±0.24 and2.74±0.28 kg(P>0.05).Conclusion Abdominal aortic balloon blockage combined with uterine artery embolization has low hysterectomy rate,can reduced blood transfusion and bleeding volume,shorten operation duration and hospital stay,and improve clinical outcomes.
Objective To research the clinical efficacy of abdominal aortic balloon blockage combined with uterine artery embolization in the treatment of pernicious placenta previa.Methods 69 pernicious placenta previa patients between April 2012 and November 2015 of our hospital were selected.All of them were taken Cesarean section operation,and divided them into control group and research group by different intervention methods.The control group was treated by uterine artery embolization,while the research group was treated by abdominal aortic balloon blockage combined with uterine artery embolization.The condition of placental implantation,intraoperative transfusion,bleeding volume,operation duration,long of stay,hysterectomy rate,Apgar score of 1 minute and 5 minutes after birth,newborn birth weight and complications of two groups were observed.Results The condition of placental implantation,such as types of penetrates the posterior wall of the bladder,implant the posterior wall of the bladder,penetrating the muscular layer,partial myolayer implantation of two groups had no statistical difference(P>0.05).The intraoperative transfusion,bleeding volume and operation duration of research group were much lower than that of control group(P<0.05).The long of stay and the hysterectomy rate of research group were much lower than that of control group(P<0.05).The Apgar 1 min score of research group and the hysterectomy rate were 8.43±0.91 and 8.83±0.94(P>0.05).The Apgar 5 min score of research group and control group were 9.58±0.64 and9.64±0.61(P>0.05).The newborn birth weight of research group and control group were 2.63±0.24 and2.74±0.28 kg(P>0.05).Conclusion Abdominal aortic balloon blockage combined with uterine artery embolization has low hysterectomy rate,can reduced blood transfusion and bleeding volume,shorten operation duration and hospital stay,and improve clinical outcomes.
引文
[1]张春华,左常婷,王谢桐.腹主动脉球囊阻断术在凶险性前置胎盘剖宫产中的作用[J].山东大学学报医学版,2016,54(9):18-21.
[2]胡宗琼,陈芳,唐丽华,等.子宫下段暂时性环扎术在中央型前置胎盘术中出血处理的应用价值[J].中国计划生育和妇产科,2016,8(10):73-76.
[3] Silver RM,Fox KA,Barton JR,et al.Centre of excellence for placenta accreta[J].Am J Obstet Gynecol,2015,212(5):561-568.
[4] Clausen C,Lonn L,Langhoff-Ross J.Management of placenta percreta:a review of published cases[J].Acta Obstet Gynecol Scand,2014,93(2):138-143.
[5] Pather S,Strockyi S,Richards A,et al.Maternal outcome after conservative management of placenta percreta at caesarean section:a report of three cases and a review of the literature[J].Aust N Z J Obstet Gynaecol,2014,54(1):84-87.
[6] Matsubara S,Kuwata T,Usui R,et al.Important surgical measures and techniques at caesarean hysterectomy for placenta praevia accreta[J].Acta Obstet Gynecol Scand,2013,92(4):372-377.
[7] Ramoni A,Strobl EM,Tiechl J,et al.Conservative management of abnormally invasive placenta:four case reports[J].Acta Obstet Gynecol Scand,2013,92(4):468-471.
[8] Clausen C,Stensballe J,Albrechtsen CK,et al.Balloon occlusion of the internal iliac arteries in the multidisciplinary management of placenta percreta[J].Acta Obstet Gynecol Scand,2013,92(4):386-391.
[9] Huang G,Zhou R,Hu Y.A new suture techniques for cesarean delivery complicated by hemorrhage in cases of placenta previa accreta[J].Int J Gynaecol Obstet,2014,124(3):262-263.
[10]袁红,孔健,张彦舫,等.腹主动脉球囊阻断术和子宫动脉栓塞术在胎盘植入治疗中的应用价值[J].临床放射学杂志,2014,33(7):1074-1077.
[11]林靓,余艳红,杨茵,等.腹剖宫产术中宫腔填塞联合腹主动脉远端预置球囊阻断治疗植入型凶险性前置胎盘[J].中国微创外科杂志,2014,14(7):608-611.
[12] Beddall H.Placenta praevia:Diagnosis and management[J].British Journal of Midwifery,2015,23(2):88-94.
[13] Panici PB,Anceschi M,Borgia ML,et al.Intraoperative aorta balloon occlusion:fertility preservation in patients with placenta previa accreta/increta[J].J Matern Fetal Neonatal Med,2012,25(12):2512-2516.
[14]杨厚林,唐仪,方主亭,等.腹主动脉阻断联合子宫动脉栓塞在9例前置胎盘并胎盘植入剖宫产手术中的应用[J].介入放射学杂志,2013,22(12):1036-1038.
[15]李青春,张建平,胡睿,等.低位腹主动脉球囊阻断术在凶险型前置胎盘剖宫产术中的应用[J].实用放射学杂志,2016,32(6):938-941.
[16]吕静,宋耕,杨慧霞.腹主动脉球囊阻断术应用于凶险型前置胎盘并胎盘植入病例报道及文献复习[J].中国计划生育和妇产科,2016,8(12):10-12.
[17]张春华,左常婷,王谢桐.腹主动脉球囊阻断术在凶险性前置胎盘剖宫产中的作用[J].山东大学学报(医学版),2016,54(09):18-21.
[18]何丽丹,陈丽红,胡继芬,等.胎盘植入患者剖宫产术前腹主动脉球囊预置阻断术的疗效[J].中国介入影像与治疗学,2015,12(06):323-326.
[19]王婷.子宫动脉栓塞术治疗中期妊娠中央性前置胎盘出血的效果观察[J].保健医学研究与实践,2017,14(1):62-63.
[20] Cali G,Forlani F,Giambanco L,et al.Prophylactic use of intravascular balloon catheters in women with placenta accreta,increta and percreta[J].Eur J Obstet Gynecol Reprod Biol,2014,179(1):36-41.
[21] Minas V,Gul N,Shaw E,et al.Prophylactic balloon occlusion of the common iliac arteries for the management of suspected placenta accreta/percreta:conclusions from a short case series.[J].Arch Gynecol Obstet,2015,291(2):461-465.
[22] Tan YL,Suharjono H,Lau NL,et al.Prophylactic bilateral internal iliac artery balloon occlusion in the management of placenta accreta:A 36-month review.[J].Med J Malaysia,2016,71(3):111.
[2]胡宗琼,陈芳,唐丽华,等.子宫下段暂时性环扎术在中央型前置胎盘术中出血处理的应用价值[J].中国计划生育和妇产科,2016,8(10):73-76.
[3] Silver RM,Fox KA,Barton JR,et al.Centre of excellence for placenta accreta[J].Am J Obstet Gynecol,2015,212(5):561-568.
[4] Clausen C,Lonn L,Langhoff-Ross J.Management of placenta percreta:a review of published cases[J].Acta Obstet Gynecol Scand,2014,93(2):138-143.
[5] Pather S,Strockyi S,Richards A,et al.Maternal outcome after conservative management of placenta percreta at caesarean section:a report of three cases and a review of the literature[J].Aust N Z J Obstet Gynaecol,2014,54(1):84-87.
[6] Matsubara S,Kuwata T,Usui R,et al.Important surgical measures and techniques at caesarean hysterectomy for placenta praevia accreta[J].Acta Obstet Gynecol Scand,2013,92(4):372-377.
[7] Ramoni A,Strobl EM,Tiechl J,et al.Conservative management of abnormally invasive placenta:four case reports[J].Acta Obstet Gynecol Scand,2013,92(4):468-471.
[8] Clausen C,Stensballe J,Albrechtsen CK,et al.Balloon occlusion of the internal iliac arteries in the multidisciplinary management of placenta percreta[J].Acta Obstet Gynecol Scand,2013,92(4):386-391.
[9] Huang G,Zhou R,Hu Y.A new suture techniques for cesarean delivery complicated by hemorrhage in cases of placenta previa accreta[J].Int J Gynaecol Obstet,2014,124(3):262-263.
[10]袁红,孔健,张彦舫,等.腹主动脉球囊阻断术和子宫动脉栓塞术在胎盘植入治疗中的应用价值[J].临床放射学杂志,2014,33(7):1074-1077.
[11]林靓,余艳红,杨茵,等.腹剖宫产术中宫腔填塞联合腹主动脉远端预置球囊阻断治疗植入型凶险性前置胎盘[J].中国微创外科杂志,2014,14(7):608-611.
[12] Beddall H.Placenta praevia:Diagnosis and management[J].British Journal of Midwifery,2015,23(2):88-94.
[13] Panici PB,Anceschi M,Borgia ML,et al.Intraoperative aorta balloon occlusion:fertility preservation in patients with placenta previa accreta/increta[J].J Matern Fetal Neonatal Med,2012,25(12):2512-2516.
[14]杨厚林,唐仪,方主亭,等.腹主动脉阻断联合子宫动脉栓塞在9例前置胎盘并胎盘植入剖宫产手术中的应用[J].介入放射学杂志,2013,22(12):1036-1038.
[15]李青春,张建平,胡睿,等.低位腹主动脉球囊阻断术在凶险型前置胎盘剖宫产术中的应用[J].实用放射学杂志,2016,32(6):938-941.
[16]吕静,宋耕,杨慧霞.腹主动脉球囊阻断术应用于凶险型前置胎盘并胎盘植入病例报道及文献复习[J].中国计划生育和妇产科,2016,8(12):10-12.
[17]张春华,左常婷,王谢桐.腹主动脉球囊阻断术在凶险性前置胎盘剖宫产中的作用[J].山东大学学报(医学版),2016,54(09):18-21.
[18]何丽丹,陈丽红,胡继芬,等.胎盘植入患者剖宫产术前腹主动脉球囊预置阻断术的疗效[J].中国介入影像与治疗学,2015,12(06):323-326.
[19]王婷.子宫动脉栓塞术治疗中期妊娠中央性前置胎盘出血的效果观察[J].保健医学研究与实践,2017,14(1):62-63.
[20] Cali G,Forlani F,Giambanco L,et al.Prophylactic use of intravascular balloon catheters in women with placenta accreta,increta and percreta[J].Eur J Obstet Gynecol Reprod Biol,2014,179(1):36-41.
[21] Minas V,Gul N,Shaw E,et al.Prophylactic balloon occlusion of the common iliac arteries for the management of suspected placenta accreta/percreta:conclusions from a short case series.[J].Arch Gynecol Obstet,2015,291(2):461-465.
[22] Tan YL,Suharjono H,Lau NL,et al.Prophylactic bilateral internal iliac artery balloon occlusion in the management of placenta accreta:A 36-month review.[J].Med J Malaysia,2016,71(3):111.