双侧髂内动脉球囊临时阻断术在凶险性前置胎盘剖宫产术中的应用-东南大学学报医学版

双侧髂内动脉球囊临时阻断术在凶险性前置胎盘剖宫产术中的应用

单位：1. 江苏省淮安市妇幼保健院产科, 江苏淮安 223002;
2. 江苏省淮安市妇幼保健院介入科, 江苏淮安 223002

分类号：R714.7

出版年·卷·期（页码）：2017·36·第六期（1019-1023）

摘要：

目的：探讨双侧髂内动脉球囊临时阻断术在凶险性前置胎盘剖宫产术中的应用。方法：回顾性分析2015年12月至2016年7月在江苏省淮安市妇幼保健院产科收治的12例凶险性前置胎盘患者，术前预置球囊于双侧髂内动脉内，娩出胎儿后迅速充盈球囊，观察术中出血量、输血情况、手术时间、手术并发症，以及是否子宫切除及随访情况。结果：本组12例患者均完整保留子宫，无子宫切除。术中失血量（200.0±901.5）ml，术中输入红细胞悬液（625.0±537.9）ml（4例同期输入血浆），手术时间（69.8±21.5）min，4例（33.3%）未合并胎盘植入，8例（66.7%）合并胎盘植入，2例（16.7%）边缘前置胎、3例（25.0%）部分前置胎盘和7例（58.3%）完全前置胎盘，9例（75.0%）娩胎儿后立即球囊封堵，3例（25.0%）为出血较多或严重时球囊封堵，出院随访母婴无严重并发症和后遗症。结论：双侧髂内动脉球囊临时阻断术可用于治疗凶险性前置胎盘。

Objective: To explore the application of bilateral posterior iliac artery balloon occlusion in the cesarean section of the pernicious placenta previa. Methods: From December 2015 to July 2016 in Huai'an maternal and child health hospital of Jiangsu province, 12 cases pernicious placenta previa patients were enrolled in this study. Preoperative balloons were placed in bilateral internal iliac arteries and delivered to fetuses. After the rapid filling the balloon, the amount of bleeding, blood transfusion, operation time, surgical complications, and whether the hysterectomy and follow-up were observed and recorded. Results: 12 patients in this group completely preserved uterus, no one got hysterectomy. Intraoperative blood loss was (200.0±901.5) ml. Intraoperative infusion of erythrocyte suspension was (625.0±537.9) ml (4 cases underwent plasma input). The operation time was (69.8±21.5) min, 4 cases (33.3%) did not complicate placenta accrete and 8 cases complicated placenta accrete. 2 cases (16.7%) had complicated edge placenta previa, 3 cases (25.0%) had partial placenta previa and 7 cases (58.3%) complicated placenta previa. 9 cases (75.0%) were treated with immediate balloon occlusion after delivery, and 3 (25.0%) had balloon occlusion as severe blood loss. All patients had no serious complications. Conclusion: Bilateral temporary balloon occlusion of the internal iliac artery can be used for the treatment of pernicious placenta previa.

参考文献：

[1] CHATTOPADHYAY S K,KHARIF H,SHERBEENI M M.Placenta praevia and accreta after previous caesarean section[J].Eur J Obstet Gynecol Reprod Biol,1993,52(3):151-156.
[2] 应豪,阮晟鸣,王德芬.胎盘植入的诊治进展[J].实用妇产科杂志,2007,23(6):335-336.
[3] 何玉甜,陈敦金.凶险型前置胎盘诊断和处理的再认识[J].中华围产医学杂志,2015,07(18):494-486.
[4] 丰有吉.妇产科学[M].3版.北京:人民卫生出版社,2015:156-159.
[5] 梅又文,罗丹.预置髂内动脉球囊在胎盘植入及前置胎盘中的应用[J].现代妇产科进展,2014,9(8):659-660.
[6] MACHADO LSM.Emergency peripartum hysterectomy:incidence,indications,risk factors and outcome[J].N Am J Med Sci,2011,3(8):358-361.
[7] TAN C H,TAY K H,SHEAH K,et al.Perioperative endovascular internal iliac artery occlusion balloon placement in management of placenta accreta[J].Am J Roentgenol,2007,189(5),1158-1163.
[8] 匡静,杨奕梅,秦占雄.凶险型前置胎盘术前行双侧髂内动脉球囊放置术临床价值评价[J].云南医药,2014,35(6):658-659.
[9] BODNER L J,NOSHER J L.GRIBBIN C.et al.Balloon-assisted occlusion of the internal iliac artetries in with placenta accrete/percreta[J].Cardiovasc Intervent Radiol,2006,29(3):354-361.
[10] CAMEVALE F C,KONDO M M,de OLIVEIRA SOUSA W Jr,et al.Periperative temporary occlusion of the internal iliac arteries as prophylaxis in cesarean section at risk of hemorrhage in placenta accreta[J].Cardiovase Intervent Radiol,2011,34(4):758-764.
[11] MASAMOTO H,UEHARA H,GIBO M,et al.Elective use of aortic balloon occlusion in cesarean hysterectomy for placenta previa percreta[J].Gynecol Obstet Invest,2009,67(2):92-95.
[12] 张功霖,姜永能,马润玫,等.髂内动脉球囊临时置入在五例凶险性前置胎盘剖宫产中的应用[J].介入放射学杂志,2012,12(12):991-993.
[13] BRENT R L.Utilization of developmental basic science principles in the evaluation of reproductive risks from pre-and postconception environmental radiation exposure[J].Teratology,1999,59(4):182-204.
[14] 秦占雄,秦瑞芬,尹磊,等.双侧髂内动脉球囊置入及取胎术后盲栓在凶险性中央前置胎盘中的应用[J].云南医药,2016,37(5):536-538.
[15] 彭方亮,周晓.凶险性前置胎盘剖宫产术中早期结扎双侧子宫动脉上行支的临床应用[J].重庆医学,2015,44(22):3131-3132.

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