腹主动脉球囊阻断辅助下提拉宫颈行子宫下段螺旋式缝合术在植入型凶险型前置胎盘中的应用

发布时间：2018-03-15 07:31

本文选题：凶险型前置胎盘　切入点：胎盘植入　出处：《现代妇产科进展》2017年10期 　论文类型：期刊论文

【摘要】：目的:对植入型凶险型前置胎盘的孕妇,计划性剖宫产术中采用腹主动脉球囊阻断辅助下提拉宫颈,行子宫下段螺旋式缝合术的有效性和安全性进行评估。方法:选取18例经B型彩色超声和磁共振成像(MRI)联合诊断为植入型凶险型前置胎盘的孕妇,均行计划性剖宫产(保留子宫意愿),手术孕周(36.78±1.63)周。剖宫产术前行腹主动脉球囊预置管,娩出胎儿并结扎脐带后,采用腹主动脉球囊临时阻断,剥离胎盘,提拉宫颈,行子宫下段螺旋式缝合术。术后必要时行双侧子宫动脉栓塞术。回顾分析患者的术中失血量、术后24h失血量、子宫切除率、输血量、预置腹主动脉球囊时间、腹主动脉球囊阻断时间、胎儿和产妇的辐射剂量、术后血管并发症、外科并发症及产褥期并发症。结果:18例孕妇术中视诊和术后病理均诊断为凶险型前置胎盘伴胎盘植入。剖宫产术中失血量(2061±1709)ml,术后24h失血量(228±141)ml,子宫切除率5.55%,12例输血,输注红细胞悬液量(1148±1061)ml,血浆量(491±403)ml。腹主动脉球囊预置管时间为(4.17±1.25)min,腹主动脉球囊阻断时间为(15.83±8.01)min;胎儿辐射剂量(9±5.50)mGy,产妇辐射剂量(43.29±47.64)mGy。外科并发症1例(膀胱损伤),无血管并发症和产褥期并发症发生。结论:腹主动脉球囊阻断辅助下提拉宫颈行子宫下段螺旋式缝合术是控制植入型凶险型前置胎盘患者术中、术后出血与保留子宫的一种安全和有效的联合治疗方法。
[Abstract]:Objective: to study the effect of abdominal aorta balloon occlusion on uterine cervix in pregnant women with implantative placenta previa during planned cesarean section. Methods: 18 pregnant women who were diagnosed as implantative and dangerous placenta previa via B color ultrasound combined with magnetic resonance imaging (MRI) were evaluated for their efficacy and safety. All patients were given planned cesarean section (preserving the intention of uterus, gestational week 36.78 卤1.63) weeks. The abdominal aorta balloon catheter was performed before cesarean section. After the fetus was delivered and the umbilical cord was ligated, the abdominal aortic balloon was used to temporarily block the placenta and pull the cervix. Spiral suture of the lower segment of uterus was performed. Bilateral uterine artery embolization was performed when necessary after operation. Blood loss during operation, blood loss at 24 hours after operation, hysterectomy rate, blood transfusion volume, and balloon time of abdominal aorta were retrospectively analyzed. Abdominal aortic balloon occlusion time, radiation dose of fetus and parturient, postoperative vascular complications, Results during operation and postoperative pathology, 18 pregnant women were diagnosed as dangerous placenta previa with placenta accreta. Blood loss during cesarean section was 2061 卤1709 ml, blood loss during 24 hours after operation was 228 卤141 ml, hysterectomy rate was 5.55% and blood transfusion was 5. 55%. The volume of erythrocyte suspension was 1148 卤1061ml, the plasma volume was 491 卤403ml. The preset catheter time of abdominal aorta balloon was 4.17 卤1.25 min, the time of abdominal aortic balloon occlusion was 15.83 卤8.01 min, the fetal radiation dose was 9 卤5.50 mGy, and the radiation dose of puerpera was 43.29 卤47.64mGy.Surgical complications occurred in 1 case (bladder injury, no vascular complication). Conclusion: assisted by abdominal aortic balloon occlusion, the lower uterine segment spiral suture is used to control the implantation of severe placenta previa previa. A safe and effective combination of postoperative bleeding and uterine retention.
【作者单位】：南京医科大学第一附属医院产科;南京医科大学第一附属医院介入放射科;
【基金】：江苏省妇幼健康科研项目(No:F201658)
【分类号】：R719.8

【相似文献】