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目的:探讨侧入逆行向上分离膀胱法在凶险型前置胎盘剖宫产术中的应用效果。方法:选择2011年1月至2014年7月在江西省妇幼保健院行剖宫产分娩的凶险型前置胎盘可疑胎盘植入者91例。患者在剖宫产术时均需分离膀胱,其中51例采用侧入逆行向上分离膀胱法(研究组),40例采用经子宫前壁向下分离膀胱法(对照组)。比较两组的术中出血量、输血量、平均手术时间、术后平均住院时间、膀胱损伤率、子宫切除率。结果:研究组的平均手术时间、术后平均住院时间、术中出血量、输血量、子宫切除率及膀胱损伤率均低于对照组,差异有统计学意义(P<0.05)。结论:侧入逆行向上方法分离膀胱可明显减少凶险型前置胎盘伴胎盘植入剖宫产手术中膀胱损伤,有利于术中出血控制,减少子宫切除率,缩短手术及住院时间。该法操作简单,疗效确切,值得推广应用。
Objective: To investigate the effect of lateral retrograde upward segmental bladder method in cesarean section of dangerous placenta previa. Methods: From January 2011 to July 2014, 91 cases of suspected placenta accreta placenta patients with cesarean delivery in Jiangxi Maternity and Child Health Hospital were selected. In the cesarean section, patients were required to separate the bladder. Among them, 51 cases were recruited into the bladder with retrograde retrograde approach (study group) and 40 patients with the bladder method (control group) through the anterior wall of the uterus. The blood loss, blood transfusion, average operation time, average postoperative hospital stay, bladder injury rate and hysterectomy rate were compared between the two groups. Results: The average operation time, average postoperative hospital stay, intraoperative blood loss, blood transfusion, hysterectomy rate and bladder injury rate of the study group were significantly lower than those of the control group (P <0.05). CONCLUSIONS: Side-to-side retrograde upwards separation of the bladder can significantly reduce the risk of bladder injury in aggressive placenta previa with cesarean section during placenta accreta. It is helpful for intraoperative bleeding control, reducing the rate of hysterectomy and shortening the operation and hospital stay. The method is simple, effective and worth promoting.