【摘要】 目的探讨前置胎盘数字化三维模型上构建的子宫切口模拟线在前置胎盘剖宫产术中的应用价值。方法选取2014年1月至2016年1月因前置胎盘在南方医科大学南方医院行剖宫产的单胎孕妇45例作为研究组,利用其术前磁共振(MRI)数据进行在体胎盘-子宫-骨盆数字化三维模型重建,在三维模型上多点测量前壁胎盘边缘与耻骨联合上缘水平线的垂直距离,确定胎盘边缘线,并根据胎盘在子宫前壁的位置对前置胎盘进行分型。根据胎盘分型和胎盘边缘线,在无胎盘区构建子宫切口模拟线。以前置胎盘边缘线和子宫切口模拟线为指导选择前置胎盘剖宫产术中子宫切口。同期用其他方法确定子宫切口的前置胎盘患者89例作为对照组,观测两组手术总失血量、输血率、手术时间、子宫切除率、术后住院天数、新生儿Apgar评分等围术期相关指标。结果研究组术前确定的胎盘位置与术中确定的胎盘位置符合率100%。对预计可避开胎盘患者,按照子宫切口模拟线切开子宫,胎盘避开率100%。研究组和对照组孕妇失血量(mL)(678.65±649.54 vs.933.96±695.25)、手术时间(min)(65.13±27.38 vs.86.88±54.43)、输血率(24.45%vs.42.69%)比较差异均有统计学意义(P<0.05),对照组的失血量、输血率明显高于研究组,手术时间明显长于研究组。两组孕妇产后24 h出血量≥1000 mL发生率、子宫切除率、病死率、新生儿Apgar评分(1、5 min)<7分的发生率等比较差异均无统计学意义(P>0.05)。结论胎盘数字化三维模型上构建的胎盘边缘线和子宫切口模拟线在指导前置胎盘手术时,能有效避开胎盘,减少术中出血,缩短手术时间,为临床中前置胎盘剖宫产术有效避开胎盘提供了一个新方法,具有一定的应用前景。更多还原

【Abstract】 Objective To study the application value of uterine incision analog line based on the digital 3D model of placenta previa in placenta previa cesarean section.Methods Totally 45 women in the third trimester diagnosed with placenta previa voluntary to take cesarean section after the MRI scan in Nanfang Hospital of Southern Medical University were recruited in the study as new method group.Use those MRI data to reconstruct digital three-dimensional model of the placenta,and build the uterine incision analog line in order to guide the uterine incision selection in cesarean section.Compare them with 89 cases at the same period in which the new method was not used in placenta previa cesarean section,and observe surgical blood loss,transfusion rate,operative time,hysterectomy rate,postoperative hospital stay,Apgar score and other indicators related to the perioperative period.Results In the new method group,we could exactly determine the location of the edge of the placenta,and according to the uterine incision analog line,we could absolutely avoid the placenta.Comparing the two group,we could see blood loss was(678.65±649.54)m L and(933.96±695.25)m L,operation time(65.13±27.38)min and(86.88±54.43)min,blood transfusion rate 24.45%(11/45)and 42.69%(38/89),respectively,differences being statistically significant(P<0.05).There was no difference between two groups in terms of the incidence of 24 h postpartum hemorrhage ≥1000 m L,hysterectomy rate,mortality or Apgar score(1,5 min)<7 percent age.Conclusion The placenta edge and the uterine incision analog line(M line)based on the digital 3D model of placenta previa can effectively avoid the placenta,reduce the degree of bleeding and shorten operative time in placenta previa operation.It provides a new method to avoid placenta during operation and has a certain application prospect.更多还原