子宫修复整形术治疗凶险性前置胎盘伴胎盘植入患者的疗效评价

Evaluation of therapeutic effect of uterine repair and plastic surgery for pernicious placenta previa accompanied with placental implantation

摘要

目的 探讨子宫修复整形术治疗凶险性前置胎盘伴胎盘植入患者的临床效果。方法 回顾分析2017年1月至2023年12月在宁波大学附属妇女儿童医院分娩的合并胎盘植入的凶险性前置胎盘患者135例,剖宫产术中行子宫修复整形术病例纳入观察组(n=55),其他凶险性前置胎盘伴胎盘植入病例纳入对照组(n=80).比较两组患者在以下方面的差异:手术时长、术中出血量、自体血回输量、异体红细胞输注量、血浆输注量、血小板输注量、术中附加止血措施、子宫切除率、弥漫性血管内凝血(DIC)发生率、切口愈合不良发生率以及术后住院时间等指标。结果 相较于对照组,观察组患者术中出血量、自体血回输量、异体红细胞输注量、血浆输注量以及术后住院时长等指标均显著降低(Z值分别为15.565、8.828、10.892、15.582、18.041,均P<0.05);观察组的宫腔球囊或纱条填塞率显著高于对照组(χ²=7.239,P=0.007);观察组的子宫切除发生率较对照组显著下降(χ²=15.600,P<0.001).两组间的手术时间、DIC、术后发热以及切口愈合不良等并发症的发生率无显著差异(P>0.05)。结论 子宫修复整形术在治疗凶险性前置胎盘合并胎盘植入的临床实践中展现出显著优势,该术式不仅能有效控制术中出血量,同时可显著降低子宫切除率,由于其止血效果可靠且安全性较高,这一术式在临床应用中具有重要意义,具备推广的价值.

Abstract

Objective To explore clinical effect of uterine repair and plastic surgery for treatment of pernicious placenta previa accompanied with accreta (placental implantation). Methods The clinical data of 135 parturient women with pernicious placenta previa accompanied with accreta who delivered in The Affiliated Women and Children's Hospital of Ningbo University from January 2017 to December 2023 were retrospectively analyzed. 55 parturient women with pernicious placenta previa accompanied with accreta who underwent uterine repair and plastic surgery following cesarean section were included in observation group and other 80 parturient women with pernicious placenta previa accompanied with accreta who underwent routine cesarean section rather than uterine repair and plastic surgery were included in control group. The operation time, intraoperative bleeding volume, autologous blood transfusion volume, allogeneic red blood cell transfusion volume, plasma transfusion volume, platelet transfusion volume, additional intraoperative hemostatic measures, hysterectomy rate, incidence rates of disseminated intravascular coagulation (DIC) and poor incision healing, postoperative hospitalization length of the parturient women were observed and compared between the two groups. Results The intraoperative bleeding amount, autologous blood transfusion volume, allogeneic red blood cell transfusion volume, plasma transfusion volume and postoperative hospitalization length of the parturient women in the observation group were less and shorter than those in the control group, and the differences were statistically significant (Z=15.565, 8.828, 10.892, 15.582 and 18.041 respectively, all P<0.05). The rate of intrauterine balloon or gauze tamponade in the observation group was higher than that in the control group, and the difference was statistically significant (χ ²=7.239, P=0.007). The rate of hysterectomy in the observation group was significantly lower than that in the control group (χ²=15.600, P<0.001). There were no significant differences in operation time, incidence rates of DIC, postoperative fever and poor incision healing between the two groups (all P>0.05). Conclusion Uterine repair and plastic surgery exerts significant advantages in clinical treatment practise of pernicious placenta previa accompanied with placenta implantation. This procedure can effectively reduce intraoperative bleeding of the patients with placenta previa accompanied with accreta, thereby reduce rate of hysterectomy. Because of reliable hemostatic effect with a high safety, it is worthy to be popularized and applied in clinic.

关键词

子宫修复整形术 / 凶险性前置胎盘伴胎盘植入 / 术中出血量 / 子宫切除率

Key words

uterine repair and plastic surgery / pernicious placenta previa accompanied with accreta / intraoperative bleeding amount / hysterectomy rate

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基金资助

浙江省医药卫生科技项目(2022KY337)