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目的探讨子宫前壁切除及修补术治疗凶险性前置胎盘并胎盘植入的安全性和有效性。方法对2014年1月至2016年4月南方医科大学南方医院收治的45例凶险性前置胎盘并胎盘植入患者(研究组)实施子宫前壁切除及修补术,术中重点注意膀胱处理、子宫切口选择、子宫下段捆扎止血、胎盘处理与子宫前壁切除、子宫塑形缝合等关键步骤。与同期51例采用常规保守手术治疗方案(B-Lynch缝合、子宫下段“8”字缝合、宫腔填塞、子宫动脉结扎等)的凶险性前置胎盘患者(对照组)进行比较,比较两组患者术中及术后24 h内总失血量、输血量和输血率、手术时间、子宫切除率、产妇病死率、子宫切口愈合情况、ICU转入率、术后住院时间、住院费用、42 d子宫复旧情况。结果研究组总失血量、输血量、手术时间、ICU转入率、术后住院时间、住院费用均明显少于对照组,差异均有统计学意义(P<0.05)。对照组输血率高于研究组(98.04%vs.88.89%),但两组差异无统计学意义(P=0.065)。研究组无一例子宫切除,对照组中子宫切除3例,两组相比差异无统计学意义(P=0.229)。两组患者术后子宫切口愈合良好,无患者死亡。研究组中24例产后42d复诊,子宫复旧良好。结论子宫前壁切除及修补术能够有效减少术中出血并可完好保留子宫,操作相对简单,利于推广,为凶险性前置胎盘保留子宫手术提供了一个新的选择。
Objective To investigate the safety and efficacy of anterior hysterectomy and repair of malignant placenta previa and placenta accreta. Methods From January 2014 to April 2016, 45 cases of dangerous placenta previa and placenta accreta (study group) underwent resection and repair of anterior wall of uterus in 45 cases of Nanfang Hospital of Southern Medical University. During the operation, the focus was on bladder treatment, Uterine incision options, the lower end of the bundle strapping hemostasis, placenta processing and anterior resection of the uterus, uterine suture and other key steps. Compared with 51 cases of patients with precancerous placenta previa (control group) who underwent routine conservative surgery (B-Lynch suture, lower uterine segment, “8” suture, intrauterine packing, uterine artery ligation, etc.) Total blood loss, blood transfusion and blood transfusion, operation time, hysterectomy, maternal mortality, uterine incision healing, ICU transfer rate, postoperative hospital stay, hospitalization costs, 42 d uterine involution condition. Results The total blood loss, blood transfusion, operation time, ICU transfusion rate, postoperative hospital stay and hospitalization costs of the study group were significantly less than those of the control group (P <0.05). The blood transfusion rate of the control group was higher than that of the study group (98.04% vs.88.89%), but there was no significant difference between the two groups (P = 0.065). No case of hysterectomy in the study group, the control group, 3 cases of hysterectomy, no significant difference between the two groups (P = 0.229). Uterine incision healed well in both groups, no patient died. 24 cases of study group 42 days postpartum referral, uterine involution good. Conclusion Anterior resection and repair of uterine wall can effectively reduce intraoperative bleeding and uterine well preserved, the operation is relatively simple and conducive to the promotion of risk placenta previa retained uterine surgery provides a new option.