凶险型中央性前置胎盘手术治疗23例临床研究

目的探讨治疗凶险型中央性前置胎盘减少出血的手术方法及治疗规范。 方法采用回顾性研究方法分析2009年1月至2011年9月佛山市妇幼保健院收治的23例凶险型中央性前置胎盘产妇的手术方法和治疗结局。 结果23例患者中保留子宫19例，包括13例无胎盘植入和6例非穿透性胎盘植入患者，通过胎盘边缘切口剖宫产术结合子宫动脉上行支结扎、植入病灶局部切除、宫缩剂、B-Lynch缝合术等止血措施保留了子宫。切除子宫4例，均为穿透性胎盘植入患者，次全子宫切除术2例，全子宫切除术2例。23例患者平均出血量为(750±355)ml，其新生儿均存活。 结论应用子宫胎盘边缘切口结合预防性结扎子宫动脉上行支和(或)髂内动脉及子宫B-Lynch缝合术等止血方法，对减少凶险型中央性前置胎盘手术中出血有较好的效果。

Clinical study on surgical treatment of pernicious central placenta previa: 23 cases reports

ObjectiveTo explore operation method and standard treatment of pernicious central placenta previa in order to reducing bleeding. MethodsTwenty-three cases of pernicious central placenta praevia diagnosed in the Maternal and Child Health Care Hospital of Foshan City were retrospectively analyzed from July 2009 to June 2011. ResultsThere were 19 cases reserved uterine, including 13 cases without placenta accreta and 6 cases with placenta accreat. These cases reserved uterine by cesarean section on placental edge combining ligating ascending uterine artery, local excising placenta implantation, and B-Lynch uterine suture. Four cases were hysterectomy and placenta percreta, including 2 cases with hysterectomy and 2 cases with subtotal hysterectomy. The average amount of bleeding was 750 ± 355 ml in 23 cases and all newborns were alive. ConclusionsApplying incision of cesarean section on placental edge combining ligating ascending uterine artery and (or) internal iliac artery and B-Lynch suture were the effective ways to reduce bleeding in pernicious central placenta previa cases.