髂内动脉结扎术在凶险性前置胎盘剖宫产术中的应用

Application of ligation of internal iliac artery in cesarean section of pernicious placenta previa

摘要:

目的 探讨髂内动脉结扎术(IIAL)在凶险性前置胎盘(PPP)剖宫产术中的应用效果。方法 选取2020年1月至2023年8月于西南医科大学附属医院收治的105例PPP患者为研究对象，根据患者是否接受IIAL,将其分为干预组(接受IIAL,n=44)和对照组(未行IIAL,n=61);根据是否切除子宫，将干预组进一步分为子宫切除亚组(n=11)和子宫保留亚组(n=33)。比较不同组患者剖宫产结局。结果 干预组宫腔填纱率(20.45%vs 42.62%)及子宫动脉结扎率(34.09%vs 75.41%)均低于对照组(P<0.05),两组在术中出血量[1 200.00(800.00,2 450.00)mL vs 1 500.00(800.00,2 000.00)mL]、子宫切除率(25.00%vs 16.39%)等方面比较，差异无统计意义(P>0.05)。子宫切除亚组术前血红蛋白[104.00(85.00,108.00)g/L vs 107.00(101.00,119.00)g/L]及O型血占比(0.00%vs 39.39%)均低于子宫保留亚组(P<0.05);在术中出血量[2 800.00(2 000.00,3 500.00)mL vs 1 000.00(700.00,1 600.00)mL]、手术时间[165.00(140.00,200.00)min vs 120.00(100.00,140.00)min]等方面均高于子宫保留亚组(P<0.05)。结论 IIAL可降低PPP患者剖宫产术中宫腔填纱、子宫动脉结扎等止血术式的应用，但不能有效减少术中出血量及降低子宫切除率；纠正患者术前贫血，可减少术中出血量、降低子宫切除率。

Abstract:

Objective Toinvestigatetheapplicationeffectofinternaliliacarteryligation(IIAL)incesareansectionof perniciousplacentaprevia(PPP).Methods Theclinicaldataof105patientswithPPPadmittedtotheAffiliatedHospitalof SouthwestMedicalUniversityfromJanuary2020toAugust2023wereretrospectivelyanalyzed.Thepatientsweredivided intoaninterventiongroup(IIAL,n=44)andacontrolgroup(noIIAL,n=61)accordingtowhethertheyreceivedIIAL. Theinterventiongroupwasfurtherdividedintoahysterectomysubgroup (n=11)andauterinepreservationsubgroup (n=33)accordingtowhethertheuteruswasremovedornot.Thecesareansectionoutcomewascomparedbetweengroups. Results Therateofuterinecavityfilling (20.45% vs42.62%)anduterinearteryligation (34.09% vs75.41%)inthe interventiongroupwerelowerthanthoseinthecontrolgroup(P<0.05).Therewasnosignificantdifferencebetweenthe interventiongroupandthecontrolgroupinintraoperativebloodloss[1200.00 (800.00,2450.00)mLvs1500.00 (800. 00,2000.00)mL]andhysterectomyrate (25.00% vs16.39%)(P >0.05).ForpatientswithIIAL,thelevelof p bl r o e o o d per (0 at . i 0 v 0 e % he v m s o 3 g 9 lo .3 bi 9 n % [1 ) 0 in 4 t .0 h 0 eh (8 ys 5 t . e 0 r 0 ec , to 10 m 8 y . s 0 u 0 b ) gr g o / u L p v w s er 1 e 0 l 7 o . w 0 e 0 rt ( h 1 a 0 n 1 t . h 0 o 0 se , i 1 n 1 t 9 he .0 u 0 te ) ri g n / e L pr ] es a e n r d va t ti h o e n p s r u o b p gr o o rt u i p on (P of <0 O- .0 t 5 yp ) e , whiletheintraoperativebloodloss[2800.00 (2000.00,3500.00)mLvs1000.00 (700.00,1600.00)mL]andthe operativeduration[165.00 (140.00,200.00)minvs120.00 (100.00,140.00)min]inthehysterectomysubgroupwere higherthanthoseintheuteruspreservationsubgroup (P <0.05).Conclusion IIALcanreducetheuseofhemostatic proceduressuchasuterinecavityfillinganduterinearteryligationduringcesareansectioninpatientswithPPP,butitcannot effectivelyreducetheintraoperativebloodlossandtherateofhysterectomy.Correctionofpreoperativeanemiacanreduce intraoperativebloodlossandhysterectomyrateduringcesareansectioninpatientswithPPP.