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目的探讨凶险型前置胎盘的诊断及产后出血的治疗方法,减少产后出血量,降低子宫切除率。方法总结分析该院2005年4月—2014年11月收治的凶险型前置胎盘24例病例,对应用子宫收缩剂后子宫下段仍活动出血患者的治疗方法,就术中出血量、子宫切除数、子宫切除率等方面进行分析。结果浆肌层缝合+宫腔填塞分为10例,术中出血量1 500~3 500ml,术后子宫切除数3例,子宫切除率30%。浆肌层缝合+宫腔填塞+术后子宫动脉栓塞术(介入治疗)病例为6例,术中出血1 500~3 500ml,术后子宫切除数0例,子宫切除率0。术中子宫动脉上行支或下行支结扎术(或行止血带捆扎)+浆肌层缝合+宫腔填塞病例8例,术中出血量1 200~1 500ml,子宫切除数0例。结论应用宫缩剂基础上,采用浆肌层缝合、术中行子宫动脉结扎术或止血带捆扎子宫血管、宫腔填塞、术后介入治疗行子宫动脉栓塞等综合治疗,可使产后出血量减少,子宫切除率明显下降,单一治疗效果不如综合治疗。
Objective To investigate the diagnosis of dangerous placenta previa and the treatment of postpartum hemorrhage to reduce the amount of postpartum hemorrhage and reduce the rate of hysterectomy. Methods The clinical data of 24 cases of dangerous placenta previa treated from April 2005 to November 2014 in our hospital were analyzed retrospectively. The treatment of patients with active uterine bleeding after operation with uterine contractility was analyzed. The amount of bleeding, the number of hysterectomy , Hysterectomy rate and other aspects of analysis. Results Myometrial suture + intrauterine packing was divided into 10 cases, intraoperative bleeding 1 500 ~ 3 500ml, 3 cases of postoperative hysterectomy, hysterectomy rate of 30%. Myometrial suture + intrauterine filling + postoperative uterine artery embolization (interventional treatment) cases were 6 cases, intraoperative bleeding 1 500 ~ 3 500ml, hysterectomy after the number of 0 cases, hysterectomy rate of 0. Intraoperative uterine artery ligation or descending branch ligation (or tourniquet banding) + myometrial suture + uterine packing 8 cases, intraoperative blood loss of 1 200 ~ 1 500ml, 0 cases of hysterectomy. Conclusion The application of uterotonic agent based on the use of muscle suture, intraoperative uterine artery ligation or tourniquet strapping uterine blood vessels, uterine cavity packing, postoperative interventional treatment of uterine artery embolization and other comprehensive treatment, can reduce the amount of postpartum hemorrhage, Hysterectomy rate decreased significantly, the single treatment effect as comprehensive treatment.