黎梅

[摘要] 目的 讨论研究双侧髂内动脉球囊封堵术对治疗与控制凶险性前置胎盘剖宫产术中出血的临床疗效与意义。方法 方便选择该院科2016年1—12月产科诊断为凶险性前置胎盘徐行剖宫产术患者100例，随机分为A、B两组，各50例。A组患者行常规剖宫产术治疗；B组患者联合双侧髂内动脉球囊封堵术治疗。比较两组患者采用不同手术方式治疗后术中手术情况，恢复时间及妊娠结局，相关并发症发生概率等指标。 结果 B组术中出血量（1 064.3±266.7）mL及术中输血量（347.3±100.3）mL均显著低于A组（2 201.3±700.6）、（1 237.3±400.1）mL（P<0.05）；B组患者婴儿新生儿评分（8.75±0.27）分与A组（8.38±0.93）分，差异无统计学意义（P>0.05）。结论 行双侧髂内动脉球囊封堵术可显著减少手术过程中的出血量及输血量；同时可显著缩短术后患者恢复时间，降低各类并发症发生概率并减少子宫切除风险具有重要意义。

[关键词] 双侧髂内动脉球囊封堵术；凶险性前置胎盘剖宫产；临床疗效与意义

[中图分类号] R714 [文献标识码] A [文章编号] 1674-0742（2017）05（b）-0088-03

[Abstract] Objective To discuss the clinical curative effect and significance of internal ilica artery balloon occlusion surgery in controlling the intraoperative bleeding of dangerous placenta previa cesarean delivery. Methods 100 cases of patients with dangerous placenta previa cesarean delivery in our hospital from January to December 2016 were convenient selected and randomly divided into two groups with 50 cases in each， the group A adopted the routine cesarean delivery， while the group B adopted the internal ilica artery balloon occlusion surgery on the basis of the group A， and the intraoperative operation， recovery time， pregnant outcome and occurrence probability of related complications were compared between the two groups. Results The intraoperative bleeding amount and intraoperative infusion amount in the group B were obviously lower than those in the group A[（1 064.3±266.7）mL， （347.3±100.3）mL vs （2 201.3±700.6）mL，（1 237.3±400.1）mL]（P<0.05）， and there was no obvious difference in the newborns apgars score between the two groups[（8.75±0.27）point vs （8.38±0.93）point]（P>0.05）. Conclusion The internal ilica artery balloon occlusion surgery can obviously reduce the intraoperative bleeding amount and infusion amount， obviously shorten the recovery time of patients after operation， reduce the occurrence probability of various complications and reduce the incision risks of uterus， which is of important significance.

[Key words] Internal ilica artery balloon occlusion surgery； Dangerous placenta previa cesarean delivery； Clinical curative effect and significance

兇险性前置胎盘是指附着于既往有剖宫产史，该研究妊娠为前置胎盘且胎盘附着于子宫瘢痕处，伴或不伴胎盘植入[1]。凶险性前置胎盘尤其是合并胎盘植入患者病情极为凶险，具有瘢痕子宫与前置胎盘两大特点，可导致剖宫产术中发生严重出血、失血性休克、弥漫性血管内凝血及子宫切除困难；同时还可引发感染及膀胱、输尿管、倡导损伤等，处理不当可能直接导致孕妇死亡，对患者的生命健康安全造成严重威胁。目前临床治疗该病多依赖产科、外科、新生儿科、麻醉科等科室进行多学科合作处理，治疗目标为保证产妇及胎儿的生命安全，及最大限度的保留患者子宫[2]。……