【摘要】：目的探討子宮前壁切除及修補術治療兇險性前置胎盤并胎盤植入的安全性和有效性。方法對2014年1月至2016年4月南方醫(yī)科大學南方醫(yī)院收治的45例兇險性前置胎盤并胎盤植入患者(研究組)實施子宮前壁切除及修補術,術中重點注意膀胱處理、子宮切口選擇、子宮下段捆扎止血、胎盤處理與子宮前壁切除、子宮塑形縫合等關鍵步驟。與同期51例采用常規(guī)保守手術治療方案(B-Lynch縫合、子宮下段"8"字縫合、宮腔填塞、子宮動脈結扎等)的兇險性前置胎盤患者(對照組)進行比較,比較兩組患者術中及術后24 h內(nèi)總失血量、輸血量和輸血率、手術時間、子宮切除率、產(chǎn)婦病死率、子宮切口愈合情況、ICU轉入率、術后住院時間、住院費用、42 d子宮復舊情況。結果研究組總失血量、輸血量、手術時間、ICU轉入率、術后住院時間、住院費用均明顯少于對照組,差異均有統(tǒng)計學意義(P0.05)。對照組輸血率高于研究組(98.04%vs.88.89%),但兩組差異無統(tǒng)計學意義(P=0.065)。研究組無一例子宮切除,對照組中子宮切除3例,兩組相比差異無統(tǒng)計學意義(P=0.229)。兩組患者術后子宮切口愈合良好,無患者死亡。研究組中24例產(chǎn)后42d復診,子宮復舊良好。結論子宮前壁切除及修補術能夠有效減少術中出血并可完好保留子宮,操作相對簡單,利于推廣,為兇險性前置胎盤保留子宮手術提供了一個新的選擇。
[Abstract]:Objective to evaluate the safety and efficacy of anterior wall hysterectomy and repair in the treatment of severe placenta previa with placenta accreta. Methods from January 2014 to April 2016, 45 patients with dangerous placenta previa associated with placenta accreta (study group) were treated with anterior wall hysterectomy and repair. The key steps are hemostasis, placenta treatment, anterior wall resection and uterine suture. A comparison was made between 51 patients with dangerous placenta previa (control group) who were treated with conventional conservative surgical procedures (B-Lynch suture, suture of lower uterine segment "8", uterine cavity tamponade, uterine artery ligation, etc.) during the same period. The total blood loss, blood transfusion and blood transfusion rate, operation time, hysterectomy rate, maternal mortality, uterine incision healing, ICU transfer rate, postoperative hospitalization time and hospitalization cost were compared between the two groups. The uterus recovered after 42 days. Results the total blood loss, blood transfusion, operation time, ICU transfer rate, postoperative hospitalization time and hospitalization cost in the study group were significantly lower than those in the control group (P0.05). The blood transfusion rate in the control group was higher than that in the study group (98.04 vs 88.89%), but there was no significant difference between the two groups (P0.065). There was no hysterectomy in the study group and 3 cases in the control group. There was no significant difference between the two groups (P < 0. 229). The uterine incision healed well in both groups, and no death occurred. In the study group, 24 cases were diagnosed at 42 days postpartum and the uterus recovered well. Conclusion anterior wall hysterectomy and repair can effectively reduce intraoperative bleeding and keep uterus intact, and the operation is relatively simple and easy to popularize, which provides a new choice for the operation of perilous placenta previa preserving uterus.
【作者單位】： 南方醫(yī)科大學南方醫(yī)院婦產(chǎn)科;
【基金】：國家自然科學基金(31271417) 2014年廣東省高等教育“創(chuàng)新強校工程”專項資金(2014KTSCX042)
【分類號】：R714.2

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