摘要
目的探讨子宫双切口在凶险性前置胎盘剖宫产术中的应用效果。方法2014年6月~2018年6月对凶险性前置胎盘(Ⅱ、Ⅲ型)行剖宫产术的43例患者,术前均行髂内动脉球囊置入+双侧输尿管支架置入,其中18例(为研究组)采用子宫双切口行胎儿娩出和胎盘取出;25例(为对照组)经单一切口行剖宫产术娩出胎儿和胎盘。结果研究组手术时间短于对照组,术中出血量及术后24h出血量均少于对照组,差异均有统计学意义(P<0.01)。研究组无一例行子宫切除、子宫动脉栓塞及转ICU;对照组7例出血凶猛而行全子宫切除术,3例术后仍有少量活动性出血行子宫动脉栓塞术成功止血,6例转ICU。研究组子宫切除率及转ICU率均明显低于对照组,差异有统计学意义(P<0.05)。所有患者均痊愈出院,无一例发生晚期产后出血,产后42d复查子宫彩超未见异常。结论凶险性前置胎盘患者行髂内动脉球囊封堵后,经子宫双切口行剖宫产术娩出胎儿和胎盘,能够快速有效地止血,减少围术期出血量,降低子宫切除率。
Objective To investigate the effect of uterine double incisions in caesarean section of pernicious placenta previa.Methods A total of 43 pernicious placenta previa women with typeⅡandⅢadmitted to our hospital from June 2014 to June 2018 were enrolled and divided into the experimental group(n=18)and the control group(n=25)according to uterine incision.All cases were placed the iliac artery balloon and the bilateral ureter stent.During the surgery of cesarean section,uterine double incisions and single incision was applied to deliver the infant and remove the placenta in the experiment group and the control group respectively.Results Compare to the control group,the operation time was shorter,the blood loss volume of intra-operation and 24 hours after the delivery of the experiment group was less,and all the differences were statistically(P<0.01).There was no hysterectomy,uterine artery embolization and conversion to ICU in the experimental group.While hysterectomy was performed in 7 cases due to serious bleeding,uterine artery embolization in 3 cases due to activity bleeding and conversion to ICU in 6 cases in the control group.There was statistical difference in the incidence of hysterectomy and conversion to ICU between the two groups(P<0.05).Conclusion After balloon occlusion of iliac artery,the surgical procedure of cesarean section via uterine double incisions to deliver the infant and remove the placenta in the patients with pernicious placenta previa can achieve the effective hemostasis quickly,reduce the peri-operative bleeding volume obviously and decrease the hysterectomy rate effectively.
作者
魏苏
张蓓
钱俊如
张艳玲
翟敬芳
夏晓琨
朱春波
WEI Su;ZHANG Bei;QIAN Jun-ru;ZHANG Yan-ling;ZHAI Jing-fang;XIA Xiao-kun;ZHU Chun-bo(Department of Obstetrics and Gynecology,Xuzhou Central Hospital,Xuzhou 221000,Jiangsu,China)
出处
《中国现代手术学杂志》
2019年第4期307-311,共5页
Chinese Journal of Modern Operative Surgery
关键词
凶险性前置胎盘
剖宫产术
子宫双切口
pernicious placenta previa
cesarean section
uterine double incision
