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中华产科急救电子杂志

中华产科急救电子杂志 ›› 2014, Vol. 03 ›› Issue (04) : 276 -279. doi: 10.3877/cma.j.issn.2095-3259.2014.04.013

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论著

三维计算机体层摄影血管成像超选择动脉栓塞术治疗胎盘植入的临床分析
覃亦伟1,†(), 张晓丽1   
  1. 1. 510800　广州，南方医科大学附属花都医院围产医学中心
  • 收稿日期:2014-05-28 出版日期:2014-11-18
  • 通信作者: 覃亦伟

Clinical analysis of three-dimensional computerized tomography angiography super selective uterine artery embolization in treating placenta increta

Yiwei Qin1,†(), Xiaoli Zhang1   

  1. 1. Department of Obstetrics and Gynecology, Huadu Hospital Affiliated to Southern Medical University, Guangzhou 510800, China
  • Received:2014-05-28 Published:2014-11-18
  • Corresponding author: Yiwei Qin
  • About author:
    Corresponding author: Qin Yiwei, Email:
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覃亦伟, 张晓丽. 三维计算机体层摄影血管成像超选择动脉栓塞术治疗胎盘植入的临床分析[J]. 中华产科急救电子杂志, 2014, 03(04): 276-279.

Yiwei Qin, Xiaoli Zhang. Clinical analysis of three-dimensional computerized tomography angiography super selective uterine artery embolization in treating placenta increta[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2014, 03(04): 276-279.

目的

探讨三维计算机体层摄影血管成像(computerized tomography angiography, CTA)超选择胎盘植入的供血动脉栓塞治疗胎盘植入患者的治疗效果。

方法

收集并分析2010年2月至2013年12月就诊于南方医科大学附属花都医院围产医学中心70例胎盘植入患者的临床资料，35例患者应用三维CTA超选择胎盘植入的供血动脉栓塞为实验组，35患者例选择子宫动脉栓塞为对照组，对两组患者的术前一般情况、术中、术后及预后情况进行比较。

结果

实验组胎盘组织排出时间为(7.05±1.28) d、术后β-hCG为(5.35±0.67) U/L、术后出血量为(9.78±0.34) ml，对照组胎盘组织排出时间为(12.36±1.95) d、术后β-hCG为(6.97±0.99 )U/L、术后出血量为(15.22±1.96)ml，两组患者各项临床检测指标比较，t值分别为4.102，4.009，4.135，P均<0.01，差异有统计学意义。实验组无患者发生宫腔感染，但对照组有3例。

结论

三维CTA辅助下行超选择胎盘植入的供血动脉治疗胎盘植入具有安全、微创、止血迅速、可保留子宫等优点，有较高的临床应用价值。

关键词: 胎盘，侵入性, 栓塞，治疗性, 三维CTA, 结果评价
Objective

To evaluate the clinical efficacy of three-dimensional computerized tomography angiography(CTA) super selective supplying artery embolization in treating placenta increta; The supplying artery is for placenta increta.

Methods

The clinical data of 70 placenta increta patients were collected in Huadu Hospital Affiliated to Southern Medical University from February 2010 to December 2013. The patients were divided into two groups: 35 patients with three-dimensional CTA super selective artery embolization were in the treatment group, 35 patients with uterine artery embolization were in the control group. The clinical condition about patients during preoperative, intraoperative, and postoperative and prognosis of two groups were compared.

Results

In the treatment group, the time of placental tissue discharge were (7.05±1.28) days, the level of β-human chorionic gonadotropin(β-hCG) was (5.35±0.67) U/L, and the amount of postoperative bleeding was (9.78±0.34)ml. In the control group, the data were (12.36±1.95) days, (6.97±0.99)U/L, and (15.22±1.96)ml, respectively. There were significant differences in the two groups; t=4.102, 4.009, and 4.135 (all P value<0.01). There was none patient had uterus cavity infection in control group, but there were 3 patients had uterus cavity infection in treatment group.

Conclusions

The advantages of three-dimensional CTA super selective uterine artery embolization are safe, mini-invasive, stopping bleeding quickly, and reserving uterine for placenta increta patients. The therapeutic method has high clinical application value.

Key words: Placenta accreta, Embolization, therapeutic, Three-dimensional CTA, Outcome assessment
表1 两组患者术前一般资料比较(±s)
组别 例数 β-hCG水平(U/L) 累计术前出血量(ml) 术前收缩压(mmHg) 术前舒张压(mmHg)
实验组 35 3 660±285 1 530±340 98±13 63±17
对照组 35 3 592±297 1 670±261 92±14 59±15
t值 ? 1.621 1.532 1.590 1.615
P值 ? >0.05 >0.05 >0.05 >0.05
图1 三维CTA构建出子宫动静脉及属支。A：子宫动静脉及属支；B：植入性胎盘的供血动脉(箭头所指为子宫动脉卵巢支及输卵管支)
表2 两组患者术中情况比较(±s)
组别 例数 介入治疗时间(min) 曝光时间(s) 造影剂剂量(ml) 造影剂速率(ml/s)
实验组 35 30.37±9.22 11.70±1.55 1.5±0.21 3.12±0.27
对照组 35 40.95±11.96 18.14±1.87 2.0±0.97 4.00±0.33
t值 ? 4.233 4.156 4.178 4.210
P值 ? <0.01 <0.01 <0.01 <0.01
图2 胎盘植入患者栓塞术前及术后DSA造影图像。A：胎盘造影剂充盈显著，无外溢(箭头所指); B：子宫动脉增粗，植入性胎盘供血动脉分支多(箭头所指); C：对照组明胶海绵颗粒栓塞后，子宫动脉充盈减少(箭头所指); D：实验组明胶海绵颗粒栓塞后，对于子宫动脉基本无影响(箭头所指)
表3 两组患者术后指标的比较(±s)
组别 例数 胎盘排出时间(d) 术后β-hCG(U/L) 术后出血量(ml)
实验组 35 7.05±1.28 5.35±0.67 9.78±0.34
对照组 35 12.36±1.95 6.97±0.99 15.22±1.96
t值 ? 4.102 4.009 4.135
P值 ? <0.01 <0.01 <0.01
表4 两组患者预后情况的比较
组别 例数 β-hCG恢复正常时间(d，±s) 月经异常 宫腔感染
例数 百分比(%) 例数 百分比(%)
实验组 35 8.02±0.36 1 2.9 0 0
对照组 35 13.94±1.87 3 8.5 3 8.5
统计值 ? t＝4.576 χ2＝4.553 χ2＝4.591
P值 ? <0.01 <0.01 <0.01
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