腹主动脉球囊阻断术与改良后子宫血管阻断术在胎盘植入性疾病患者再次剖宫产中的应用比较

doi:10.3969/j.issn.1006-5725.2024.13.010

Abstract

Abstract:

Objective To investigate the impact of preoperative abdominal aortic balloon occlusion and modified uterine vascular occlusion on repeat cesarean delivery in patients with placenta previa and placenta accreta spectrum disorders. Methods A total of 97 patients with placenta previa and placenta accreta spectrum disorders who underwent repeat cesarean section at Hefei Maternal and Child Health Hospital between April 2016 and December 2022 were included in this study. Among them， the control group consisted of 48 cases who underwent abdominal aortic balloon occlusion before the operation， while the observation group comprised 49 cases who underwent modified uterine vascular occlusion during the operation. Intraoperative and postoperative complications were observed and compared between the two groups. Results The number of bilateral uterine artery embolization post-operation and the average hospitalization cost in the observation group were significantly lower compared to those in the control group （P < 0.05）. However， there were no significant differences observed between the two groups regarding average intraoperative blood loss， red blood cell suspension transfusion volume， hysterectomy rate， and bladder rupture rate （P > 0.05）. Conclusions Both surgical methods effectively reduce intraoperative bleeding in the treatment of repeat cesarean section in patients with placenta previa and placenta accreta spectrum disorders. However， modified uterine vascular occlusion demonstrates no complications related to vascular intervention or X-ray exposure， ensuring high maternal and child safety while significantly reducing hospitalization costs. Therefore， it is highly recommended for clinical promotion.

Key words: placenta accreta spectrum disorders, placenta previa, uterine vascular occlusion, abdominal aortic balloon occlusion

CLC Number:

R719

Dehong LIU,Xianxia CHEN,Chenmin ZHENG,Shuhua. LIU. Comparison of the application of abdominal aortic balloon occlusion and modified uterine artery occlusion in patients with placenta accreta undergoing repeat cesarean section[J]. The Journal of Practical Medicine, 2024, 40(13): 1822-1826.

Figures/Tables 5

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References 26

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项目	对照组（n = 48）	观察组（n = 49）	t/χ²值	P值
年龄（x ± s，岁）	32.06 ± 4.81	32.20 ± 3.93	0.159	0.874
妊娠次数（x ± s，次）	3.79 ± 1.25	3.51 ± 1.06	-1.193	0.236
流产次数（x ± s，次）	1.54 ± 1.29	1.24 ± 0.93	-1.306	0.195
剖宫产次（x ± s，次）	1.19 ± 0.45	1.24 ± 0.93	0.371	0.711
分娩孕周（x ± s，周）	35.68 ± 3.01	36.17 ± 2.33	0.901	0.370
PAS分级［例（%）］
Grade 2级	29（60.41）	30（61.22）	0.007	0.935
Grade 3a级	8（16.67）	8（16.33）	0.002	0.964
Grade 3b级	11（22.92）	10（20.41）	0.090	0.764
Grade 3c级	0（0）	1（2.04）	0.990	1.000

项目	对照组（n = 48）	观察组（n = 49）	t/χ²值	P值
术中平均出血（x ± s，mL）	1 387.50 ± 802.84	1 291.25 ± 834.43	-0.561	0.572
Grade 2级术中出血量（x ± s，mL）	968.97 ± 559.40	970.00 ± 384.30	0.008	0.993
Grade 3a级术中出血量（x ± s，mL）	1 821.50 ± 883.88	1 185.00 ± 624.80	-1.640	0.123
Grade 3b级术中出血量（x ± s，mL）	2 428.57 ± 1 032.12	1 800.00 ± 515.48	-1.600	0.125
输血例数［（例）%］	38（79.17）	32（65.31）	2.319	0.128
输红细胞悬液量（x ± s，U）	4.76 ± 4.78	3.31 ± 3.56	-1.701	0.092
启动大输血方案［（例）%］	8（16.67）	3（6.12）	2.681	0.121
出现失血性休克［（例）%］	7（14.58）	2（4.08）	3.177	0.091
子宫切除［（例）%］	9（18.75）	7（14.29）	0.351	0.595
膀胱破裂［（例）%］	3（6.25）	3（6.12）	0.001	1.000
使用全身麻醉例数［（例）%］	48（100.00）	10（20.41）	63.893	< 0.001

项目	对照组（n = 48）	观察组（n = 49）	t/χ²值	P值
血管手术并发症数［（例）%］	2（4.17）	0（0.00）	2.085	0.242
术后使用双侧子宫动脉栓塞术数［（例）%］	8（16.67）	1（2.04）	6.162	0.016
住院费用（x ± s，元）	34 144.33 ± 15 303.60	22 279.16 ± 9 059.68	4.635	< 0.001
新生儿出生体质量（x ± s，g）	2 689.79 ± 6 909.07	2 863.06 ± 568.24	1.341	0.183
新生儿1 min Apgar 评分（x ± s，分）	8.73 ± 0.82	8.90 ± 0.51	1.216	0.228
新生儿窒息数［（例）%］	5（10.42）	2（4.08）	1.453	0.268

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Comparison of the application of abdominal aortic balloon occlusion and modified uterine artery occlusion in patients with placenta accreta undergoing repeat cesarean section

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