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目的探讨子宫动脉栓塞术在凶险性前置胎盘伴胎盘植入中的临床应用价值。方法收集2010年1月—2014年12月唐山市妇幼保健院产科收治的97例单胎妊娠,孕周大于32周的凶险性前置胎盘伴植入性胎盘或穿透性胎盘的患者。根据是否行子宫动脉栓塞术分为二组:1栓塞术组55例,即术前股动脉预置管,娩出胎儿后评估术中胎盘植入深度与范围进行子宫动脉栓塞术,随后处理胎盘,必要时切除子宫;2非栓塞术组42例,即娩出胎儿后,处理胎盘,根据术中胎盘植入情况,行宫腔填塞纱布压迫止血、子宫动脉上行支结扎术、B-lynch缝合术等,必要时切除子宫。比较二组患者的术中情况及临床结局。结果栓塞术组的患者失血量少于非栓塞术组,差异有统计学意义﹙P<0.05﹚。栓塞术组ICU入住率、子宫切除率、产后出血率、DIC发生率均低于非栓塞术组,差异有统计学意义﹙P<0.05﹚。二组患者的术后住院时间、产褥感染率及新生儿窒息发生率差异均无统计学意义(P>0.05)。结论子宫动脉栓塞术可以明显减少术中出血量,降低手术风险,改善凶险性前置胎盘患者的临床结局,值得推广应用。
Objective To investigate the clinical value of uterine artery embolization in the treatment of dangerous placenta previa with placenta accreta. Methods One hundred and ninety-seven singleton pregnancies were enrolled from January 2010 to December 2014 in Maternity and Child Health Care Hospital of Tangshan City. Patients with infertile placenta previa or gestational weeks greater than 32 weeks with implanted placenta or penetrating placenta were enrolled. According to whether the uterine artery embolization is divided into two groups: 1 embolization group of 55 cases, preoperative femoral artery preoperative tube, after the delivery of fetal assessment of intraoperative placenta accreta depth and extent of uterine artery embolization, followed by the treatment of the placenta, If necessary, the uterus was removed.2 In the non-embolization group, 42 cases were treated with the placenta after the fetus was delivered. According to the intraoperative placenta accretion, the uterine cavity was filled with gauze to stop bleeding, the uterine artery was lined up, the B-lynch suture was performed, Excise the uterus if necessary. The two groups of patients were compared intraoperative situation and clinical outcome. Results The blood loss of patients in the embolization group was less than that of the non-embolization group, the difference was statistically significant (P <0.05). ICU occupancy rate, hysterectomy rate, postpartum hemorrhage rate and DIC incidence in embolization group were lower than those in non-embolization group, the difference was statistically significant (P <0.05). There were no significant differences in postoperative hospital stay, puerperal infection rate and neonatal asphyxia between the two groups (P> 0.05). Conclusion Uterine artery embolization can significantly reduce the amount of intraoperative bleeding, reduce the risk of surgery and improve the clinical outcome of dangerous placenta previa, it is worth to promote the application.