不同设备引导下动脉临时球囊阻断技术在凶险性前置胎盘剖宫产术中的临床应用

李骏; 王世平; 袁骏; 杨勤飞; 李庆红; 许志梅; 李志海; 田杰

不同设备引导下动脉临时球囊阻断技术在凶险性前置胎盘剖宫产术中的临床应用

1. 云南昆钢医院放射科
2. 云南昆钢医院妇产科
3. 云南昆钢医院超声科

基金项目:

基金：云南省临床重点专科建设项目 (2014-38); 昆明市卫生科技计划项目 (2018-09-04-001); 昆明市卫生科技人才暨“十百千”工程后备人选项目 (2014-56);

计量
- 文章访问数: 1694
- HTML全文浏览量: 614
- PDF下载量: 27
- 被引次数: 0
出版历程
- 收稿日期: 2018-07-19

Clinical Application of Different Devices Guided Arterial Temporary Balloon Occlusion Technique in Dangerous Placenta Previa Caesarean Delivery

Funds:

基金：云南省临床重点专科建设项目 (2014-38); 昆明市卫生科技计划项目 (2018-09-04-001); 昆明市卫生科技人才暨“十百千”工程后备人选项目 (2014-56);

摘要

摘要: 目的探讨不同设备引导下动脉临时球囊阻断技术在前置胎盘剖宫产术中疗效评定及特点。方法收集昆钢医院放射科自2016年7月至2018年8月配合产科、超声科开展不同设备引导下临时球囊阻断患者共26例。26例患者均经超声和 (或) MRI诊断凶险性前置胎盘, 在不同的引导设备下行双侧髂内或髂总动脉预埋临时球囊, 待胎儿取出时立即充盈球囊阻断髂动脉血流, 根据产科手术进度及出血情况适时撤出球囊。结果本组26例患者动脉临时球囊预埋阻断均获得成功, 其中1例患者因发现右侧子宫动脉假性动脉瘤形成, 行栓塞治疗。26例患者阻断时间3～15 min, 术中出血量400～1 000 m L。病例无子宫切除及术后输血, 所有新生儿均存活。结论针对凶险性前置胎盘患者在剖宫产术中行动脉临时球囊阻断, 能够减少剖宫产术中出血量及相关并发症的发生率。该技术具有创伤小、安全性高、疗效确切等特点, 近年来已在临床推广应用。
- 前置胎盘 /
- 动脉阻断临时球囊 /
- 剖宫产术
Abstract: Objective To discuss the characteristics and efficacy evaluation of the different devices guided arterial temporary balloon occlusion technique in dangerous placenta previa caesarean delivery. Methods The patients who had visited obstetrics department as total 26 were collected from July 2016 to August 2018. All patients were diagnosed as dangerous placenta previa by ultrasound or (and) magnetic resonance imaging (MRI) and had been received the arterial temporary balloon occlusion pre-caesarean delivery. Guided with different devices, the balloon was pre-embedded in the bilateral internal or common iliac artery. Immediately blocked the blood flow of iliac artery after the fetal delivered. Withdrawn the balloon according to the obstetric operation progression and bleeding.Results All the 26 patients were succeful in the arterial temporary balloon pre-embedded, and 1 patient of which taken embolotherapy 1 patient due to pseudo-aneurysm formation of right uterine artery. The occlusion time was about 3-15 mins while the intra-operation bleeding amount was about 400-1000 m L in all the patients. There was no hysterectomy or post-operative blood transfusion. All the newborns were survival. Conclusion The arterial temporary balloon occlusion technique in dangerous placenta previa caesarean delivery can decrease the amount of bleeding during the caesarean delivery and the incidence of related complication. It has advantages such as micro-invasion, strong safety and curative effect, and has been widely used in clinic.
- Dangerous placenta previa /
- Arterial temporary balloon occlusion technique /
- Caesarean delivery

HTML全文

参考文献(20)

[1]潘春红, 吴玉花, 韦玉岚, 143例凶险型前置胎盘发病的影响因素及围生期结局分析[J].重庆医学, 2017, 46 (17) :2377-2380.
[2]陈英.凶险性前置胎盘29例[J].实用医学杂志, 2012, 28 (4) :684-685.
[3] 李力, 妇产科学[M].8版, 北京:人民卫生出版社, 2013:126-129.
[4]陈瑜.晚期妊娠凶险性前置胎盘23例临床分析[J].临床医药实践, 2011, 20 (5) :346-348.
[5]刘兴会, 杨慧霞.产后出血预防和处理措施评价[J].中华围产医学杂志, 2013, 16 (8) :449-451.
[6]	[6]WEDISINGHE L, MACLEOD M, MURPHY D J.Use of oxytocin to prevent haemorrhage at caesarean section:a survey of practice in the United Kingdom[J].Eur J Oynnecol Reprod Biol, 2008, 137 (2008) :27-30.
[7]	[7]WHO Guidelines Approved by the Guidelines Review Committee.WHO guidelines for the management of postpartum haemorrhage and retained placenta[M].Genrva:World Health Organization, 2009:1-10.
[8]	[8]BEVERLY W, RASHA D, JILL D, et al.Treatment of postpartumhaemorrhage with sublingual misoprostol versus oxytocin in women not exposed to oxytocin during labour:a double-blind, randomized, non-inferiority trial[J].Lancet, 2010, 375 (9710) :210-216.
[9]申洁, 刘菊菊.子宫腔填塞纱条联合欣母沛治疗疤痕子宫产后出血的临床分析[J].中外医疗, 2018, 37 (34) :35-37.
[10]	[10]EI-HAMAMY E, WRIGHT A, B-LYNCH C.The B-Lynch suture technique for postpartum haemorrhage:a decade of experience and outcome[J].J Obstet Gynaecol, 2009, 29 (4) :278-283.
[11]	[11]PRICE N, B-LYNCH C.Technical description of the B-Lynch brace suture for treatment of massive postpartum hemorrhage ang review of published cases[J].Int J Fertil Womens Med, 2005, 50 (4) :148-163.
[12] 刘兴会, 徐先明, 段涛, 等.实用产科手术学[M].北京:人民卫生出版社, 2014:161-162.
[13]	[13]HUNTER L A.Exploring the role of uterine artery embolization in the management of postpartum hemorrhage[J].J Perinat Neonatal Nurs, 2010, 24 (3) :207-214.
[14]王明, 张力, 刘兴会, 等.中央性前置胎盘围产期急症子宫切除术18例分析[J].中国妇幼保健, 2012, 27 (7) :984-987.
[15]	[15]TEIXIDOR V M, CHANGRAHARAN E, MONETA M V, et al.The role of interventional radiology in reducing haemorrhage ang hysterectomy following caesarean section for morbidly adherent placenta[J].Clin Radiol, 2014 69 (2014) :345-351.
[16]张翼云, 姜永能, 石潆, 等.临时球囊置入髂总动脉在凶险性前置胎盘伴胎盘植入中的应用[J].实用放射学杂志, 2016, 32 (2) :259-262.
[17]	[17]MASAMOTO H, UGHARA H, GIBO M, et al.Elective use of aortic balloon oc-clusion in cesarean hysterectomy for placenta previa percreta[J].Gynecol Obstet Invest, 2009, 67 (2) :92-95.
[18]	[18]SHIH J C, LIU K L, SHYU M K.Temporary balloon occlusion of the commom iliac artery:new approach to bleeding control during cesarean hysterectomy for placenta percreta[J].Am J Obstet Gynecol, 2005, 193 (5) :1756-1758.
[19]	[19]HANSCH E, CHITKARA U, MCALPINE J, et al.Pelvic arterial embolization for control of obstetric hemorrhage:a five-year experience[J].Am J Obstet Gynecol, 1999, 180 (6) :1454-1460.
[20]陈坤前, 李发旺, 朱恩全, 等.球囊封堵在产科大出血的临床应用[J].介入放射学杂志, 2017, 26 (5) :408-411.

相关文章(20)

[1]	王硕, 孙爱, 张慧杰, 尤杨, 魏立业, 李柳. 心肌缺血预适应在紫杉醇释放冠脉球囊导管扩张术中的应用, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20211225
[2]	杨少华, 陈轶晖, 洪茂林, 胡晟, 张小文. 良性胆肠吻合口狭窄球囊扩张与再手术治疗的疗效比较, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20210135
[3]	高燕, 马静, 明澄, 娄凡, 孙美华. 咽鼓管球囊扩张联合鼓膜置管术在儿童复发性分泌性中耳炎中的疗效, 昆明医科大学学报.
[4]	他林昆, 黄燕玲, 陆永萍. 超声评分法联合增强型血流显示技术在凶险型前置胎盘合并胎盘植入中的应用, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20201112
[5]	吕燕芬, 陆永萍, 孙月. 子宫动脉栓塞术介入治疗剖宫产疤痕妊娠后的超声观察分析, 昆明医科大学学报.
[6]	仝蕊, 卢丽娟, 雷俊华, 柴娟, 曹静, 曹娟. 多种超声联用诊断瘢痕子宫并前置胎盘植入, 昆明医科大学学报.
[7]	陶建平, 屈启才, 周臣, 李冠菲, 邵明琨, 夏丽滨. 超声引导下髂总动脉阻断联合氨甲环酸预防前置胎盘产后出血, 昆明医科大学学报.
[8]	朱艳玲, 牛兆仪, 靳晴, 李丽荣, 马雄涛, 马永红. 超声征象评分法诊断凶险性前置胎盘合并胎盘植入的应用, 昆明医科大学学报.
[9]	史绍凤, 苏纲, 彭博, 张宇. 不同麻醉方法对前置胎盘剖宫产产妇和胎儿的影响, 昆明医科大学学报.
[10]	王晓华, 李春梅, 谢晓君, 徐健. 术前预置髂内动脉球囊联合子宫下段环形缝扎在凶险性前置胎盘致产后出血中的应用, 昆明医科大学学报.
[11]	侯晓梅, 祁文瑾. 中期妊娠胎盘前置状态出血引产行介入治疗的护理总结, 昆明医科大学学报.
[12]	宋仕刚, 吴迪, 白平. 低位腹主动脉球囊临时阻断在复杂髋臼骨折手术中的应用, 昆明医科大学学报.
[13]	马翔. 腹主动脉球囊低位临时阻断血流在高位骶骨肿瘤手术中的相关应用, 昆明医科大学学报.
[14]	张德琳. 心理护理在球囊扩张术治疗环咽肌失弛缓症中的疗效观察, 昆明医科大学学报.
[15]	张文慧. 凶险型前置胎盘手术治疗围术期综合治疗方法及疗效临床评价, 昆明医科大学学报.
[16]	朱蓓. 凶险型前置胎盘围手术期的护理配合, 昆明医科大学学报.
[17]	刘丽丽. 多学科联合救治植入性凶险型前置胎盘策略探讨, 昆明医科大学学报.
[18]	陈菲. 球囊阻断腹主动脉手术中乌司他丁对MDA及TNF-α的影响, 昆明医科大学学报.
[19]	袁晓峰. 球囊扩张椎体后凸成形术治疗老年胸腰椎爆裂骨折临床疗效观察, 昆明医科大学学报.
[20]	张素仙. 子宫动脉栓塞术治疗剖宫产术后子宫疤痕妊娠的临床分析, 昆明医科大学学报.