【摘要】 目的探讨凶险性前置胎盘伴宫颈植入的诊治方法。方法回顾性分析2017年1月至2019年1月江西省妇幼保健院收治的凶险性前置胎盘伴胎盘植入96例患者的临床资料,其中32例伴宫颈植入(宫颈植入组),64例伴子宫下段植入(子宫下段植入组),比较2组病例术中出血量、输血量、术后血红蛋白水平、手术止血方法、术后并发症等。结果 (1)宫颈植入组术中出血量2000～2975 ml,平均2500 ml,显著高于子宫下段植入组(1000～1500 ml,平均1200 ml),(Z=-6.634,P=0.001);输红细胞悬液、血浆、血小板及冷沉淀的量亦显著多于子宫下段植入组,P均<0.05;(2)子宫下段植入组中57例(89.06%)采取子宫血管结扎进行止血,高于宫颈植入组20例(62.5%),χ~2=9.48,P<0.05;宫颈植入组宫颈环形缝合术28.13%(9/32)和子宫切除率达34.38%(11/32),高于子宫下段植入组的9.38%(6/64)和1.56%(1/64),χ~2=5.69和18.11,P<0.05;(3)宫颈植入组失血性休克及膀胱损伤的发生率分别为56.25%(18/32)、15.63%(5/32),高于子宫下段植入组的14.06%(9/64)、1.56%(1/64),P<0.05。结论凶险性前置胎盘伴宫颈植入患者病情更凶险;对宫颈植入患者术前应准确评估病情程度,术中选择合适的止血措施,控制其出血量,在保障孕产妇安全的前提下,降低子宫切除率。更多还原

【Abstract】 Objective To investigate the diagnosis and the treatment of pernicious placenta previa with cervical accretion to improve the outcome of pregnancy. Methods Retrospectively analyzed 96 cases of pernicious preplacental placenta with placental accretion treated in Jiangxi Provincial Maternal and Child Health Care Hospital from January 2017 to January 2019. Thirty-two cases with cervical implantation were in the cervical implantation group, 64 cases with lower uterine implantation were in the lower uterine implantation group. The bleeding volume, blood transfusion volume, postoperative hemoglobin level, hemostatic method and postoperative complications were compared between the two groups. Results(1) The amount of bleeding in the cervical implantation group was 2000-2975 ml, with an average of 2500 ml, which was significantly higher than that in the lower uterine implantation group(1000-1500 ml, with an average of 1200 ml),(Z=-6.634, P=0.001); The amount of red blood cell suspension, plasma, platelets and cryoprecipitate were also significantly higher than that of the lower uterine implantation group(P<0.05).(2) Fifty-seven cases(89.06%) in the lower uterine segment implantation group were treated with uterine vascular ligation for hemostasis, which was higher than 20 cases(62.5%) in the cervical implantation group( χ~2=9.48, P<0.05). In the cervical implantation group, the rates of cervical circular suture and hysterectomy were 28.13%(9/32) and 34.38%(11/32), respectively, which were higher than those in the lower uterine implantation group, 9.38%(6/64) and 1.56%(1/64), χ~2=5.69 and 18.11, P<0.05.(3) The incidence of hemorrhagic shock and bladder injury were 56.25%(18/32) and 15.63%(5/32) in cervical implantation group, respectively, which were higher than that of 14.06%(9/64) and 1.56%(1/64) in the lower uterine implantation group(P<0.05). Conclusions The condition of the patients with pernicious placenta previa complicated with cervical implantation is more dangerous. It is important to accurately evaluate the severity of the pregnant women with placenta previa before the operation, choose appropriate hemostatic measures to control hemorrhage in operation and minimize hysterectomy based on the safety of pregnant women.更多还原