子宫双切口联合宫颈提拉式缝合法在穿透性胎盘植入术中的应用

doi:10.12280/gjfckx.20210151

摘要/Abstract

摘要：

目的: 评价子宫双切口联合宫颈提拉式缝合法在穿透性胎盘植入手术中的临床应用效果。方法: 选择2016年1月—2019年12月于甘肃省妇幼保健院住院手术分娩的根据术前超声检查诊断并在术中确诊为前置胎盘合并穿透性胎盘植入孕妇,对其中39例穿透性胎盘植入合并宫颈内口有胎盘侵犯的患者行子宫双切口联合宫颈提拉式缝合术式,回顾性分析39例孕妇的一般情况,术中、术后情况及围生儿结局等。结果: 39例孕妇分娩时中位孕周为35周,所有新生儿预后良好,平均术中出血量为（2 083.33±927.60）mL,输血量为（1 190.38±718.68）mL,手术时间为（160.13±56.96）min,平均住院日中位数为6 d。39例孕妇中,4例分离粘连时出现膀胱损伤,4例出现一过性凝血功能异常,6例术后出现发热,给予对症治疗后痊愈。无一例子宫切除及严重术后并发症的发生,术后均恢复良好。结论: 子宫双切口联合宫颈提拉式缝合法在穿透性胎盘植入合并宫颈内口有胎盘侵犯的孕妇手术中止血效果显著,降低了子宫切除率,可以临床推广应用。

关键词: 子宫切开术, 前置胎盘, 侵入性胎盘, 剖宫产术, 缝合技术

Abstract:

Objective:To evaluate the effect of double uterine incision combined with cervical lifting suture in the operation of placenta percreta.Methods: From January 2016 to December 2019, data from the patients diagnosed with placenta previa and percreta by prenatal ultrasonic and confirmed by intraoperative findings at the Gansu Provincial Maternity and Child Care Hospital were collected. 39 cases of patients with placenta percreta and placenta invasion in the cervix were treated with double uterine incision combined with cervical lifting suture. The general situation, intraoperative and postoperative conditions and perinatal outcomes of pregnant women were collected and analyzed retrospectively.Results: The median gestational weeks of 39 pregnant women were 35 weeks. The prognosis of all newborns was good. The intraoperative blood loss and blood transfusion volume was （2 083.33±927.60） mL and （1 190.38±718.68） mL, respectively. The operation time was （160.13±56.96） min. The median hospitalization days were 6 days. Bladder injury occurred in 4 patients when adhesion was separated. Transient coagulation dysfunction occurred in 4 patients. Fever occurred in 6 patients after operation. All patients were cured after symptomatic treatment. No hysterectomy or serious postoperative complications occurred. All patients recovered well and discharged smoothly.Conclusions: Double uterine incision combined with cervical lifting suture has significant hemostatic effect in the operation of pregnant women with placenta percreta and placenta invasion in the cervix orifice, which reduces the hysterectomy rate and is worthy of clinical application.

Key words: Hysterotomy, Placenta previa, Placenta accreta, Cesarean section, Suture techniques

孟照琰, 刘小晖, 刘小玲, 张玉芳, 何晓春, 董燕. 子宫双切口联合宫颈提拉式缝合法在穿透性胎盘植入术中的应用[J]. 国际妇产科学杂志, 2021, 48(6): 670-674.

MENG Zhao-yan, LIU Xiao-hui, LIU Xiao-ling, ZHANG Yu-fang, HE Xiao-chun, DONG Yan. Application of Double Uterine Incision Combined with Cervical Lifting Suture in the Operation of Placenta Percreta[J]. Journal of International Obstetrics and Gynecology, 2021, 48(6): 670-674.

图/表 3

图1 术中子宫切口图注：A 宫体部取第一切口娩出胎儿,分离膀胱与子宫下段粘连取第二切口;B 止血带环扎子宫下段,由第二切口剥除胎盘及剪除子宫下段植入无法剥除的组织。

图2 术中缝合图注：A Allis 钳夹子宫颈内口以下无胎盘附着的子宫颈管组织;B 连续压迫缝合宫颈内口及子宫下段组织。

图3 子宫成形术后

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