植入型凶险型前置胎盘计划性剖宫产术中子宫动脉结扎阻塞及宫腔填充术的有效性和安全性

Efficacy and safety of uterine artery ligation and occlusion combined with intrauterine packing in planned cesarean section for invasive and dangerous placenta previa

摘要

目的 探究植入型凶险型前置胎盘计划性剖宫产术中采用子宫动脉结扎阻塞及宫腔填充术的有效性和安全性。方法 选取2019年12月至2021年12月唐山市妇幼保健院收治的132例植入型凶险型前置胎盘计划性剖宫产术治疗患者为研究对象,按不同的血管阻断方式分为子宫动脉栓塞术联合宫腔填充治疗组(对照组)和子宫动脉结扎联合宫腔填充治疗组(观察组),观察比较两组患者的手术时间、术中出血量、术中输血量、膀胱损伤率,并观察记录两组母婴结局情况,包括新生儿1min Apgar评分、子宫切除率、凝血功能异常发生率.记录患者术后不良反应的发生情况,包括发热、慢性盆腔疼痛、伤口愈合不良、术后血栓形成、月经量降低等。结果 观察组患者的手术时间、膀胱损伤率均较对照组更低(t=4.428和5.621,P<0.05),术中出血量、术中输血量未见显著差异(t=1.472和1.729,P>0.05),两组新生儿出生1min Apgar评分未见显著差异(t=0.257,P>0.05),但观察组产妇的子宫切除率、凝血功能异常发生率显著低于对照组(t=3.722和4.628,P<0.05),两组患者均未发生严重的产科并发症,其中观察组患者发热、慢性盆腔疼痛、术后血栓形成、伤口愈合不良、术后月经量降低的发生率均显著低于对照组,差异具有统计学意义(t=6.274、4.726、3.872、3.872和4.218,P<0.05)。结论 子宫动脉结扎术和子宫动脉造影栓塞术对植入型凶险型前置胎盘患者具有一定的临床疗效,其中子宫动脉结扎手术时间短,术后并发症发生率低,具有较好的有效性和安全性.

Abstract

Objective To investigate the efficacy and safety of uterine artery ligation and occlusion combined with uterine packing in planned cesarean section for invasive and dangerous placenta previa. Methods From December 2019 to December 2021, 132 cases of patients treated with planned cesarean section for invasive and dangerous placenta previa admitted to Tangshan Maternal and Child Health Hospital were selected as the research objects. They were divided into the uterine artery embolization combined with intrauterine packing treatment group (control group) and uterine artery ligation combined with intrauterine packing treatment group (observation group) according to different vascular occlusion methods. The operation time, intraoperative blood loss, intraoperative blood transfusion volume, and bladder injury rate of patients were observed and compared between the groups. Maternal and infant outcomes in the two groups were observed and recorded, including the 1-minute Apgar score of newborns, hysterectomy rate, and incidence of coagulation dysfunction. Postoperative adverse reactions in patients, including fever, chronic pelvic pain, poor wound healing, postoperative thrombosis formation, decreased menstrual flow were recorded. Results The operation time and bladder injury rate in the observation group were lower than those in the control group (t=4.428 and 5.621, respectively, P<0.05), while there was no significant difference in intraoperative blood loss and intraoperative blood transfusion volume between the two groups (t=1.472 and 1.729, respectively, P>0.05). There was no significant difference in the 1-minute Apgar score of newborns between the two groups (t=0.257, P>0.05). However, the hysterectomy rate and the incidence of coagulation dysfunction in the observation group were significantly lower than those in the control group (t=3.722 and 4.628, respectively, P<0.05). No serious obstetric complications occurred in the two groups. Among them, the incidence rates of fever, chronic pelvic pain, postoperative thrombosis formation, poor wound healing, and decreased postoperative menstrual flow in the observation group were all significantly lower than those in the control group, with statistically significant differences (t=6.274, 4.726, 3.872, 3.872 and 4.218, respectively, P<0.05). Conclusion Both uterine artery ligation and uterine artery embolization have certain clinical efficacy for patients with invasive and dangerous placenta previa. Uterine artery ligation has a short operation time and a low incidence of postoperative complications, demonstrating good efficacy and safety.

关键词

植入型凶险型前置胎盘 / 剖宫产 / 子宫动脉结扎术 / 子宫切除 / 止血效果

Key words

invasive and dangerous placenta previa / cesarean section / uterine artery ligation / hysterectomy / hemostatic effect

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基金资助

河北省2020年度医学科学研究课题计划(20201488)