CAJ | 학술논문

目的：探讨宫腔填塞联合腹主动脉远端预置球囊阻断术治疗植入型凶险型前置胎盘的效果。方法2012年4月～2013年12月，福建省立医院产科8例超声诊断植入型凶险型前置胎盘患者，剖宫产术前于腹主动脉远端预置球囊，术中切开子宫壁时充盈球囊，迅速娩出胎儿剥离胎盘，运用COOK止血球囊或宫腔塞纱止血，DSA造影提示仍有出血或子宫血管交通支丰富者行超选择子宫动脉栓塞。结果4例术中出血＜1000 ml（400～600 ml），未使用血制品。除1例因胎盘侵犯盆壁组织行子宫切除术外，其余7例均成功保留子宫。5例无需术后栓塞。除1例孕母大出血急诊入院者新生儿重度窒息外，其余新生儿Apgar评分均正常。结论剖宫产术中宫腔填塞联合腹主动脉远端预置球囊阻断术治疗植入型凶险型前置胎盘比较安全，可以有效控制术中出血，争取保留子宫。
목적：탐토궁강전새연합복주동맥원단예치구낭조단술치료식입형흉험형전치태반적효과。방법2012년4월～2013년12월，복건성립의원산과8례초성진단식입형흉험형전치태반환자，부궁산술전우복주동맥원단예치구낭，술중절개자궁벽시충영구낭，신속면출태인박리태반，운용COOK지혈구낭혹궁강새사지혈，DSA조영제시잉유출혈혹자궁혈관교통지봉부자행초선택자궁동맥전새。결과4례술중출혈＜1000 ml（400～600 ml），미사용혈제품。제1례인태반침범분벽조직행자궁절제술외，기여7례균성공보류자궁。5례무수술후전새。제1례잉모대출혈급진입원자신생인중도질식외，기여신생인Apgar평분균정상。결론부궁산술중궁강전새연합복주동맥원단예치구낭조단술치료식입형흉험형전치태반비교안전，가이유효공제술중출혈，쟁취보류자궁。
Objective To explore the clinical application of uterine packing with prophylactic distal abdominal aorta balloon occlusion for patients with pernicious placenta previa and placenta accreta . Methods A total of 8 cases of pernicious placenta previa and placenta accreta from April 2012 to December 2013 in Fujian Provincial Hospital were enrolled .Prophylactic distal abdominal aorta catheterization was carried out before operation .The balloon was inflated to block blood flow while cutting uterine wall . Uterine packing was performed after removing fetus and placenta .And then uterine artery was embolized according to the situation . Results Four cases had an intraoperative blood loss less than 1000 ml, without blood transfusion .The uterus was successfully conserved in 7 cases, except for 1 case of hysterectomy because of placenta implantation of the pelvic wall tissue .Postoperative uterine arterial embolization was not required in 5 cases.Neonates had normal Apgar scores except one had severe asphyxia due to emergent hemorrhage of mother . Conclusions This study indicates that uterine packing with prophylactic distal abdominal aorta balloon occlusion during cesarean is a safe and effective technique .It can reduce the amount of blood loss during the procedure , as well as the risk of hysterectomy .