凶险型前置胎盘伴胎盘植入剖宫产术中止血方式评价

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1、²3450²中华临床医师杂志(电子版)2014年10月第8卷第19期ChinJClinicians(ElectronicEdition),October1,2014,Vol.8,No.19²临床论著²凶险型前置胎盘伴胎盘植入剖宫产术中止血方式评价金日男钟永红【摘要】目的探讨以子宫下段横行环状压迫缝合术联合子宫下段修补术为主的子宫外压迫止血法在凶险型前置胎盘伴胎盘植入剖宫产术中的止血效果及临床应用价值。方法收集广东省韶关市粤北人民医院自2012年1月至2014年6月收治的46例凶险型前置胎盘患者的临床资料，对胎盘植入发生率、诊断、处理方法及随诊情况进行回顾性分析。结果（1）46例

2、凶险型前置胎盘中并发胎盘植入17例，发生率36.96%；穿透性胎盘植入9例，发生率19.57%。（2）术前彩色多普勒超声诊断胎盘植入7例，诊断率70.00%（7/10）；术前行MR检查诊断胎盘植入8例，诊断率为88.89%。（3）保留子宫38例（82.61%），切除子宫8例，子宫切除率17.39%。（4）术后42～61d随访8例胎盘植入保留子宫患者，均恶露干净、子宫复旧良好。结论彩色多普勒检查和盆腔MR检查可提高凶险型前置胎盘伴胎盘植入的诊断率；剖宫产术中采用以子宫下段横行环状压迫缝合术联合子宫下段修补术为主的子宫外压迫止血法，可迅速有效地减少剖宫产术中出血量，缩短手术时间，降

3、低子宫切除率。【关键词】前置胎盘；剖宫产术；胎盘植入EvaluationofdifferenthemostaticmethodsduringcaesareansectionwithperniciousplacentapreviaandplacentaaccretaJinRinan,ZhongYonghong.DepartmentofObstetricsandGynecology,AffiliatedYuebeiPeople’sHospitalofShantouUniversityMedicalCollege,Shaoguan512026,ChinaCorrespondinga

4、uthor:JinRinan,Email:jrn2004@126.com【Abstract】ObjectiveToevaluatethehemostaticeffectoftransverseannularcompressionsuturescombinedsurgicalrepairintheloweruterinesegmentanditsvalueonclinicalapplicationtocontrolpostpartumHemorrhageatcesareandeliveryforperniciousplacentapreviawithplacentaaccreta

5、.MethodsWeconductedaretrospectivestudyat46pregnantwomenwithperniciousplacentaprevia,whoweretreatedattheAffiliatedYuebeiPeople'sHospitalofShantouUniversityMedicalCollegefromJanuary2008toJune2012.Thisstudyreviewedtheincidencerates,diagnosisandtreatment.ResultsAmongthe46patients,17werediagnosed

6、perniciousplacentapraeviawithplacentaaccreta;theincidenceratewas36.5%;while9patientswereperniciousplacentapraeviawithplacentapercreta,whichincidenceratewas19.57%.TenpatientswerediagnosedbycolorDopplerultrasoundbeforeoperation;thediagnosisratewas70.00%(7/10);Eightpatientswerediagnosedbymagnet

7、ic-resonancebeforeoperation;thediagnosisratewas88.89%(8/9).Hysterectomywasusedin8cases(17.39%),and38cases(82.61%)werepreserveutero.Eightpostoperativepatientsofperniciousplacentapraeviawithplacentaaccretawerefollowedupto42-61days,notonlytheirlochiaa