作　　者： ; ; ; ; ; ; ;

机构地区： 广州医科大学

出　　处： 《中华围产医学杂志》 2018年第3期184-190,共7页

摘　　要： 目的探讨子宫下段环形切除加端端吻合术治疗凶险性前置胎盘合并胎盘植入的临床效果及术后子宫恢复情况。方法回顾性分析2016年1月至7月间广州医科大学附属第三医院收治的，采取子宫下段环形切除加端端吻合术治疗的凶险性前置胎盘合并穿透性胎盘植入3例患者的病例资料。分析患者术中出血、生命体征、血制品的用量及术后恢复等情况。结果3例患者术中生命体征平稳，术中出血分别为2000、1520及1500ml，术中输血量分别为400、200及200ml，手术时间分别为110、96及90min，术后均未出现感染，术后7d内均出院。3例患者术后随访，切口均愈合良好，血性恶露持续时间分别为33、38及28d，月经分别在术后289、179及163d恢复，且月经量均正常，无痛经。术后90d，B超检测3例患者宫颈长度分别为4．2、3．5及3．2cm；同时B超提示，宫腔形态正常，宫腔线清晰。结论子宫下段环形切除加端端吻合术可以有效地控制术中出血，保留子宫，是凶险性前置胎盘合并胎盘植入的一种较好的保守治疗方法。 Objective To investigate the efficacy of anastomosis after circular resection of lower uterine segment of uterine ends in the treatment of pernicious placenta previa combined with placenta accreta. Methods Clinical data of three patients who were diagnosed with pernicious placenta previa combined with placenta accreta and treated with circular resection of lower uterine segment and anastomosis in Third Affiliated Hospital of Guangzhou Medical University from January to July 2016 were retrospectively analyzed. Efficacy of the treatment was evaluated by analyzing blood loss, vital signs and blood transfusion during operation, postoperative recovery and other parameters. Results Vital signs of the three patients were stable during operations. The volume of blood loss and blood transfusion during operation and operation time of the three patients were respectively 2 000 ml, 400 ml and 110 min, 1 520 ml, 200 ml and 96 min, and 1 500 ml, 200 ml and 90 min. None of them had postoperative infection and all were discharged within seven days after operation. The three patients all recovered well. Lochia discharge continued for 33, 38 and 28 days, respectively. The menses were resumed respectively on the 289th, 179th and 163rd day following operation without dysmenorrhea and all women had normal volume of menstruation. The cervical lengths of the three patients were 4.2, 3.5 and 3.2 cm 90 days after operation, respectively. Results of imaging examination showed that uterine cavity were in normal shape and distinct endometrium were observed in all patients 90 days after operation. Conclusions Circular resection of lower uterine segment and anastomosis of lower ends of the uterine, which can effectively contol the intraoperative bleeding and retain the uteru, is highly effective for pernicious placenta previa combined with placenta accreta.

关 键 词： 前置胎盘 侵入性胎盘 妇科外科手术 吻合术 外科 器官保留治疗

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