子宫前壁切除及修补术治疗凶险性前置胎盘并胎盘植入疗效研究

发布时间：2018-12-26 13:44

【摘要】：目的探讨子宫前壁切除及修补术治疗凶险性前置胎盘并胎盘植入的安全性和有效性。方法对2014年1月至2016年4月南方医科大学南方医院收治的45例凶险性前置胎盘并胎盘植入患者(研究组)实施子宫前壁切除及修补术,术中重点注意膀胱处理、子宫切口选择、子宫下段捆扎止血、胎盘处理与子宫前壁切除、子宫塑形缝合等关键步骤。与同期51例采用常规保守手术治疗方案(B-Lynch缝合、子宫下段"8"字缝合、宫腔填塞、子宫动脉结扎等)的凶险性前置胎盘患者(对照组)进行比较,比较两组患者术中及术后24 h内总失血量、输血量和输血率、手术时间、子宫切除率、产妇病死率、子宫切口愈合情况、ICU转入率、术后住院时间、住院费用、42 d子宫复旧情况。结果研究组总失血量、输血量、手术时间、ICU转入率、术后住院时间、住院费用均明显少于对照组,差异均有统计学意义(P0.05)。对照组输血率高于研究组(98.04%vs.88.89%),但两组差异无统计学意义(P=0.065)。研究组无一例子宫切除,对照组中子宫切除3例,两组相比差异无统计学意义(P=0.229)。两组患者术后子宫切口愈合良好,无患者死亡。研究组中24例产后42d复诊,子宫复旧良好。结论子宫前壁切除及修补术能够有效减少术中出血并可完好保留子宫,操作相对简单,利于推广,为凶险性前置胎盘保留子宫手术提供了一个新的选择。
[Abstract]:Objective to evaluate the safety and efficacy of anterior wall hysterectomy and repair in the treatment of severe placenta previa with placenta accreta. Methods from January 2014 to April 2016, 45 patients with dangerous placenta previa associated with placenta accreta (study group) were treated with anterior wall hysterectomy and repair. The key steps are hemostasis, placenta treatment, anterior wall resection and uterine suture. A comparison was made between 51 patients with dangerous placenta previa (control group) who were treated with conventional conservative surgical procedures (B-Lynch suture, suture of lower uterine segment "8", uterine cavity tamponade, uterine artery ligation, etc.) during the same period. The total blood loss, blood transfusion and blood transfusion rate, operation time, hysterectomy rate, maternal mortality, uterine incision healing, ICU transfer rate, postoperative hospitalization time and hospitalization cost were compared between the two groups. The uterus recovered after 42 days. Results the total blood loss, blood transfusion, operation time, ICU transfer rate, postoperative hospitalization time and hospitalization cost in the study group were significantly lower than those in the control group (P0.05). The blood transfusion rate in the control group was higher than that in the study group (98.04 vs 88.89%), but there was no significant difference between the two groups (P0.065). There was no hysterectomy in the study group and 3 cases in the control group. There was no significant difference between the two groups (P < 0. 229). The uterine incision healed well in both groups, and no death occurred. In the study group, 24 cases were diagnosed at 42 days postpartum and the uterus recovered well. Conclusion anterior wall hysterectomy and repair can effectively reduce intraoperative bleeding and keep uterus intact, and the operation is relatively simple and easy to popularize, which provides a new choice for the operation of perilous placenta previa preserving uterus.
【作者单位】：南方医科大学南方医院妇产科;
【基金】：国家自然科学基金(31271417) 2014年广东省高等教育“创新强校工程”专项资金(2014KTSCX042)
【分类号】：R714.2

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