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山东大学学报(医学版) ›› 2016, Vol. 54 ›› Issue (9): 22-25.doi: 10.6040/j.issn.1671-7554.0.2016.548

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腹主动脉球囊阻断术在凶险性前置胎盘并胎盘植入剖宫产术中的应用

李继军1,左常婷2,王谢桐2,尚建强1   

  1. 1.山东省医学影像学研究所介入放射学研究室, 山东 济南 250021;2.山东大学附属省立医院妇产科, 山东 济南 250021
  • 收稿日期:2016-05-16 出版日期:2016-09-10 发布日期:2016-09-10
  • 通讯作者: 尚建强. E-mail:yysljj@sina.com E-mail:yysljj@sina.com
  • 基金资助:
    山东省科技发展计划(2014GSF118088);山东省自然科技基金(ZR2013HM067)

Application of abdominal aorta balloon occlusion in cesarean section for patients with pernicious placenta previa complicated by placenta accreta

LI Jijun1, ZUO Changting2, WANG Xietong2, SHANG Jianqiang1   

  1. 1. Department of Interventional Radiology, Shandong Medical Imaging Research Institute, Jinan 250021, Shandong, China;
    2. Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China
  • Received:2016-05-16 Online:2016-09-10 Published:2016-09-10

摘要: 目的 探讨腹主动脉球囊阻断术在凶险性前置胎盘并胎盘植入患者剖宫产术中的临床应用。 方法 回顾分析65例凶险性前置胎盘并胎盘植入患者的临床资料。全部患者均于剖宫产术前在介入室行股动脉插管并送入球囊导管,球囊放置于腹主动脉下段,手术中充盈球囊临时阻断主动脉血流。记录剖宫产术中出血量、子宫切除例数、孕妇接受射线剂量。 结果 手术中出血量200~4 500 mL,平均1 520 mL;术中、术后输红细胞0~3 600 mL,平均1 040 mL;无产妇及胎儿死亡及严重并发症。7例行子宫切除术(10.8%)。 结论 腹主动脉球囊阻断术可有效控制凶险性前置胎盘剖宫产术中出血、减少子宫切除率,辐射剂量对胎儿安全。但风险不可忽视,应严格掌握适应证。

关键词: 腹主动脉阻断, 凶险性前置胎盘, 剖宫产, 胎盘植入

Abstract: Objective To explore the clinical application of abdominal aorta balloon occlusion in cesarean section for patients with pernicious placenta previa(PPP). Methods The clinical data of 65 consecutive cases of PPP complicated with placenta accreta were retrospectively analyzed. Prophylactic abdominal aortic occlusion balloon catheter was placed transfemorally in the angiography room before surgery. Abdominal aorta occlusion was performed during the cesarean deliveries. The incidence of hysterectomia, estimated blood loss, number of transfused units of red blood cells and maternal radiation dose were recorded. Results The volume of bleeding was 200-4 500 mL(mean 1 520 mL), and transfused red blood cells was 0-3 600 mL(mean 1 040 mL). Hysterectomy was performed in 7 cases(10.8%). No serious materna1 and infant complications occurred during and after the surgery. Conclusion Balloon occlusion of the abdominal aorta in cesarean section seems to be safe and effective in controlling bleeding and risks of hysterectomia. The radiation exposure is safe to infants. However, patients should be selected strictly according to the operative indications to avoid risks of complications.

Key words: Pernicious placenta previa, Placenta implantation, Abdominal aorta occlusion, Cesarean section

中图分类号: 

  • R816.4
[1] Chattopadhyay SK, Kharif H, Sherbeeni MM. Placenta praevia and accreta after previous caesarean section[J]. Eur J Obstet Gynecol Reprod Biol, 1993, 49(9): 151-156.
[2] 王英兰, 王硕石, 张海鹰, 等. 凶险性前置胎盘127例临床分析[J]. 暨南大学学报(自然科学与医学版), 2015, 36(4): 348-352. WANG Yinglan, WANG Shuoshi, ZHANG Haiying, et al. Clinical analysis of 127 cases of pernicious placenta previa[J]. Journal of Jinan University(Natural Science & Medicine Edition), 2015, 36(4): 348-352.
[3] Andoh S, Mitani S, Nonaka A, et al. Use of temporary aortic balloon occlusion of the abdominal aorta was useful during cesarean hysterectomy for placenta accrete[J]. Masui, 2011, 60(2): 217-219.
[4] Nobuhiro N, Shunsuke I, Kota K, et al. Anesthetic management of intra-aortic balloon occlusion(IABO)for seven cases of placenta accreta-a six year experience at our institute[J]. Masui, 2014, 63(12): 1334-1338.
[5] 赵先兰, 刘传, 王艳丽, 等. 腹主动脉球囊阻断法预防凶险性前置胎盘合并胎盘植入剖宫产术中出血的价值[J]. 中华围产医学杂志, 2015, 18(7): 507-511. ZHAO Xianlan, LIU Zhuan, WANG Yanli, et al. Value of temporary ballon occlusion of abdominal aorta in prevention of bleeding during cesarean section in women with pernicious placenta previa and placenta accrete[J]. Chinese Journal of Perinatal Medicine, 2015, 18(7): 507-511.
[6] Clausen C, Lönn L, Langhoff-Roos J. Management of placenta percreta: a review of published cases[J]. Acta Obstet Gynecol Scand, 2014, 93(2): 138-143.
[7] Garmi G, Salim R. Epidemiology, etiology, diagnosis, and anagement of placenta accrete[J]. Obstet Gynecol Int, 2012, 2012: 873929. doi: 10.1155/2012/873929. Epub 2012 May 7.
[8] 杨慧霞, 余琳, 时春艳, 等. 止血带捆绑下子宫下段环形蝶式缝扎术治疗凶险性前置胎盘伴胎盘植入的效果[J]. 中华围产医学杂志, 2015, 7(18): 497-501. YANG Huixia, YU Lin, SHI Chunyan, et al. Efficiency of ring butterfly sewing in lower uterine segment aided with tourniquet in treating pernicious: placenta previa combined with placenta percreta[J]. Chinese Journal of Perinatal Medicine, 2015, 7(18): 497-501.
[9] 檀增宪, 王玉河, 胡永立.与髂外动脉有关的产后子宫大出血血管造影分析3例[J].中华放射学杂志, 2009, 43(3): 329-329.
[10] Levine AB, Kuhlman K, Bonn J. Placenta accreta: Comparison of cases managed with and without pelvic artery balloon catheters[J]. J Matern Fetal Med, 1999, 8(4): 173-176.
[11] Shrivastava V, Nageotte M, Major C, et al. Case-control comparison of cesarean hysterectomy with and without prophylactic placement of intravascular balloon catheters for placenta accrete[J]. Am J Obstet Gynecol, 2007, 197(4): 402.e1-5.
[12] Clausen C, Stensballe J, Albrechtsen CK, et al. Balloon occlusion of the internal iliac arteries in the multidisciplinary management of placenta percreta[J]. Acta Obstet Gynecol Scand, 2013, 92(4): 386-391.
[13] 梁娜. MRI在胎盘植入中的研究进展[J]. 实用放射学杂志, 2013, 29(2): 315-318. LIANG Na. MRI research progress in placenta increta[J]. Journal of Practical Radiology, 2013, 29(2): 315-318.
[14] Patel SJ, Reede DL, Katz DS, et al. Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations[J]. Radiographics, 2007, 27(6): 1705-1722.
[15] Thabet A, Kalva SP, Liu B, et al. Interventional radiology in pregnancy complications: indications, technique, and methods for minimizing radiation exposure[J]. Radiographics, 2012, 32(1): 255-274.
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