子宫修补成形术在凶险性前置胎盘并胎盘植入剖宫产术中的临床应用
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摘要
目的探讨子宫修补成形术在凶险性前置胎盘并胎盘植入剖宫产术中的临床应用效果。方法 2015年12月至2018年3月选择凶险性前置胎盘并胎盘植入患者共91例,设为观察组与对照组,观察组42例,实施子宫修补成形术,与同期49例采用常规手术方案的患者进行比较。比较两组患者的临床效果,并对两组患者产后42d子宫复旧情况进行随访。结果观察组的手术时间、术中出血量、子宫切除率、转入ICU率、DIC的发生率、术后住院时间均明显低于对照组,差异均有统计学意义(P<0.05)。观察组与对照组除子宫切除的病例外,所有产妇子宫切口均愈合良好,均痊愈出院,未发生产妇死亡。产后42d复查彩超提示子宫复旧均良好。结论凶险性前置胎盘并胎盘植入剖宫产术中采用子宫修补成形术,疗效确切,明显减少术中出血量,降低子宫切除率,值得推广应用。
Objective To investigate the clinical effect of uterine repair and plasty in caesarean section with dangerous placenta previa and placenta implantation. Methods From December 2015 to March 2018, 91 patients with dangerous placenta previa and placenta implantation were selected as the observation group and the control group, 42 patients in the observation group underwent uterine repair and plasty, the results were compared with 49 patients in the same period who underwent routine operation. The clinical effects of the two groups were compared,and the uterine involution of the two groups was followed up 42 days after delivery. Results The operation time,intraoperative bleeding volume, hysterectomy rate, ICU transfer rate, DIC incidence rate and hospital stay in the observation group were significantly lower than those in the control group, the difference were statistically significant(P<0.05). Except for the exceptions of hysterectomy, all the incisions of the uterus in the observation group and the control group were healed and discharged without maternal death. Color Doppler ultrasonography at 42 days postpartum showed that uterus involution was good. Conclusion Uterine repair and plasty is effective in caesarean section with dangerous placenta previa and placenta implantation, it can obviously reduce the amount of bleeding and the rate of hysterectomy, it is worth popularizing and applying.
Objective To investigate the clinical effect of uterine repair and plasty in caesarean section with dangerous placenta previa and placenta implantation. Methods From December 2015 to March 2018, 91 patients with dangerous placenta previa and placenta implantation were selected as the observation group and the control group, 42 patients in the observation group underwent uterine repair and plasty, the results were compared with 49 patients in the same period who underwent routine operation. The clinical effects of the two groups were compared,and the uterine involution of the two groups was followed up 42 days after delivery. Results The operation time,intraoperative bleeding volume, hysterectomy rate, ICU transfer rate, DIC incidence rate and hospital stay in the observation group were significantly lower than those in the control group, the difference were statistically significant(P<0.05). Except for the exceptions of hysterectomy, all the incisions of the uterus in the observation group and the control group were healed and discharged without maternal death. Color Doppler ultrasonography at 42 days postpartum showed that uterus involution was good. Conclusion Uterine repair and plasty is effective in caesarean section with dangerous placenta previa and placenta implantation, it can obviously reduce the amount of bleeding and the rate of hysterectomy, it is worth popularizing and applying.
引文
[1]谢幸,苟文丽.妇产科学[M]第8版.北京:人民卫生出版社2013:126-127.
[2]中华医学会妇产科学分会产科学组.产后出血预防与处理指南(2014)[J].中华妇产科杂志,2014,49(9):641-646.
[3]peker N,Turan V,Ergenoglu M,et al.Assessment of total placenta by mangnetic resonance imaging and ultrasonography to detect placenta accreta and its variants[J].Ginekol Pol,2013,84(3)186-192.
[4]耿力,肖虹,肖李乐云,等.凶险性前置胎盘合并胎盘植入40例临床分析[J].现代妇产科进展2016,25(4):292-295.
[5]侯磊.凶险型前置胎盘并发胎盘植入23例临床分析[D].安徽医科大学,2015.
[6]黄金瑞,陈琪瑛.52例凶险型前置胎盘合并胎盘植入的临床分析[J].右江医学,2015,43(4):467-470.
[7]刘金艳,王艳丽,石进,等.凶险性前置胎盘妊娠20例临床分析[J].中国当代医药,2015,22(31):114-116.
[8]张丽祥.凶险性前置胎盘合并胎盘植入的手术方式探讨[J].中国保健营养,2016(2):136-136.
[9]蒋玉蓉,唐雅兵,游一平,等.凶险型前置胎盘合并胎盘植入64例围手术期综合治疗疗效分析[J].实用妇产科杂志,2018,34(3):227-230.
[10]刘朵朵,葛俊丽,吕小慧,等.凶险性前置胎盘合并胎盘植入的手术方式探讨[J].山西医科大学学报,2015(1):1197-1199.
[2]中华医学会妇产科学分会产科学组.产后出血预防与处理指南(2014)[J].中华妇产科杂志,2014,49(9):641-646.
[3]peker N,Turan V,Ergenoglu M,et al.Assessment of total placenta by mangnetic resonance imaging and ultrasonography to detect placenta accreta and its variants[J].Ginekol Pol,2013,84(3)186-192.
[4]耿力,肖虹,肖李乐云,等.凶险性前置胎盘合并胎盘植入40例临床分析[J].现代妇产科进展2016,25(4):292-295.
[5]侯磊.凶险型前置胎盘并发胎盘植入23例临床分析[D].安徽医科大学,2015.
[6]黄金瑞,陈琪瑛.52例凶险型前置胎盘合并胎盘植入的临床分析[J].右江医学,2015,43(4):467-470.
[7]刘金艳,王艳丽,石进,等.凶险性前置胎盘妊娠20例临床分析[J].中国当代医药,2015,22(31):114-116.
[8]张丽祥.凶险性前置胎盘合并胎盘植入的手术方式探讨[J].中国保健营养,2016(2):136-136.
[9]蒋玉蓉,唐雅兵,游一平,等.凶险型前置胎盘合并胎盘植入64例围手术期综合治疗疗效分析[J].实用妇产科杂志,2018,34(3):227-230.
[10]刘朵朵,葛俊丽,吕小慧,等.凶险性前置胎盘合并胎盘植入的手术方式探讨[J].山西医科大学学报,2015(1):1197-1199.