周绍琼

【摘要】 目的：观察宫腔填塞联合腹主动脉球囊预置术在植入型凶险型前置胎盘治疗中的临床效果。方法：将2017年11月-2019年2月在笔者所在医院确诊的52例植入型凶险型前置胎盘患者，随机分为观察组和对照组，各27例，观察组采用宫腔填塞联合腹主动脉球囊预置术，对照组采用传统常规剖宫产术，观察比较两组手术指标、血液学指标、新生儿情况及并发症发生情况。结果：观察组手术时间、术中出血量及术中输血量均优于对照组，差异均有统计学意义（P<0.05）。观察组手术前后血红蛋白差值低于对照组，差异有统计学意义（P<0.05）。两组术后纤维蛋白原、D-二聚体、CK-MB及LDH指标比较差异无统计学意义（P>0.05）。两组新生儿出生体重及出生1、5、10 min后Apgar评分比较差异无统计学意义（P>0.05）。对照组行子宫切除2例，观察组未发生子宫切除病例，出现左下肢深静脉血栓1例，经溶栓治疗后恢复正常。结论：宫腔填塞联合腹主动脉球囊预置术治疗植入型凶险型前置胎盘效果良好，安全性高，明显减少术中出血，显著控制术后并发症，有较大的临床推广价值。

【关键词】 植入型凶险型前置胎盘 宫腔填塞 腹主动脉球囊预置术 剖宫产术

[Abstract] Objective： To observe the clinical effect of intrauterine tamponade combined with abdominal aortic balloon preset procedure in the implantation of sinister placenta previa. Method： A total of 52 patients with implanted sinister placenta previa were enrolled in our hospital from November 2017 to February 2019. The patients were randomly divided into the observation group and the control group， 27 cases in each group. The observation group used intrauterine tamponade combined with abdominal aortic balloon preset surgery， the control group used conventional cesarean section， the surgical indicators， hematological indicators， neonatal conditions and complications were observed and compared. Result： The time of operation， intraoperative bleeding and intraoperative blood transfusion in the observation group were better than those in the control group， the differences were statistically significant （P<0.05）. The difference of hemoglobin between the observation group before and after surgery was lower than that of the control group， the difference was statistically significant （P<0.05）. There were no significant differences in the levels of fibrinogen， D-dimer， CK-MB and LDH between the two groups （P>0.05）. There were no significant differences in birth weight and Apgar score after 1， 5 and 10 min of birth between the two groups （P>0.05）. There were 2 cases of hysterectomy in the control group. There was no hysterectomy in the observation group， and 1 case of deep vein thrombosis in the left lower extremity. It returned to normal after thrombolytic therapy. Conclusion： Intrauterine tamponade combined with abdominal aortic balloon preset procedure for the treatment of implanted sinister placenta previa has good effect and high safety， significantly reduce intraoperative hemorrhage， significantly control postoperative complications， and has great clinical promotion value.

兇险型前置胎盘是产科医师面临的巨大难题，是指既往行剖宫产术，此次妊娠胎盘位于剖宫产疤痕处，如果合并胎盘植入则危险系数更高，由于胎盘位置的关系，如果术中处理不当，会出现大出血引发失血性休克等严重情况，甚至危及患者生命[1-2]。由于植入的胎盘往往累及周围脏器，相对于其他类型的前置胎盘手术难度更大，极易损伤泌尿系统、肠道及盆腔软组织，并且新生儿健康也受到潜在威胁。所以……