子宫动脉栓塞术在凶险性前置胎盘伴胎盘植入中的应用效果

发布时间：2018-01-12 09:39

本文关键词：子宫动脉栓塞术在凶险性前置胎盘伴胎盘植入中的应用效果　出处：《中国煤炭工业医学杂志》2016年01期 　论文类型：期刊论文

【摘要】：目的探讨子宫动脉栓塞术在凶险性前置胎盘伴胎盘植入中的临床应用价值。方法收集2010年1月—2014年12月唐山市妇幼保健院产科收治的97例单胎妊娠,孕周大于32周的凶险性前置胎盘伴植入性胎盘或穿透性胎盘的患者。根据是否行子宫动脉栓塞术分为二组:1栓塞术组55例,即术前股动脉预置管,娩出胎儿后评估术中胎盘植入深度与范围进行子宫动脉栓塞术,随后处理胎盘,必要时切除子宫;2非栓塞术组42例,即娩出胎儿后,处理胎盘,根据术中胎盘植入情况,行宫腔填塞纱布压迫止血、子宫动脉上行支结扎术、B-lynch缝合术等,必要时切除子宫。比较二组患者的术中情况及临床结局。结果栓塞术组的患者失血量少于非栓塞术组,差异有统计学意义龴P0.05㖞。栓塞术组ICU入住率、子宫切除率、产后出血率、DIC发生率均低于非栓塞术组,差异有统计学意义龴P0.05㖞。二组患者的术后住院时间、产褥感染率及新生儿窒息发生率差异均无统计学意义(P0.05)。结论子宫动脉栓塞术可以明显减少术中出血量,降低手术风险,改善凶险性前置胎盘患者的临床结局,值得推广应用。
[Abstract]:Objective to investigate the clinical value of uterine artery embolization in the treatment of dangerous placenta previa with placenta accreta. Methods 97 cases of obstetrical treatment in Tangshan Maternal and Child Health Hospital from January 2010 to December 2014 were collected. Pregnancy. Patients with dangerous placenta previa with accreta or penetrating placenta were divided into two groups according to whether uterine artery embolization was performed. Uterine artery embolization was performed to evaluate the depth and extent of placenta implantation after delivery of the fetus, and then the placenta was treated and, if necessary, the uterus was removed. 2in the non-embolization group, 42 cases were treated with placenta after delivery of the fetus. According to the placenta accretion during the operation, the uterine cavity packing gauze compression and hemostasis, uterine artery ascending branch ligation and B-lynch suture were performed. When necessary hysterectomy. Compared the two groups of patients during the operation and clinical outcome. Results Embolization group of patients with less blood loss than the non-embolization group, the difference was statistically significant. P0.05? The ICU occupancy rate, hysterectomy rate and postpartum hemorrhage rate in the embolization group were significantly lower than those in the non-embolization group. P0.05? There was no significant difference in postoperative hospitalization time, puerperal infection rate and neonatal asphyxia between the two groups. Conclusion uterine artery embolization can significantly reduce the amount of intraoperative bleeding. Reducing the risk of surgery and improving the clinical outcome of patients with dangerous placenta previa is worth popularizing.
【作者单位】：河北省唐山市妇幼保健院;
【基金】：唐山市科学技术研究与发展支撑计划项目(编号:121302131b)
【分类号】：R714.462
【正文快照】： 1933年英国学者Chattopadhyay提出了凶险性前置胎盘的概念:指以往有剖宫产史,本次妊娠为前置胎盘,且胎盘附着于原子宫瘢痕部位,此类患者出现胎盘植入率超过50%[1]。胎盘植入在组织病理学中依据胎盘侵入子宫肌层的程度分为粘连性胎盘、植入性胎盘和穿透性胎盘[2]。植入性和穿透

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