探讨双侧髂内动脉预置球囊导管并术后栓塞在凶险性前置胎盘剖宫产中的应用价值和意义。

168例凶险性前置胎盘产妇分为观察组及对照组。观察组104例在剖宫产术前行双侧髂内动脉预置球囊导管，胎儿娩出后，胎盘分离前立即充盈球囊阻断髂内动脉。术后返回介入科行双侧子宫动脉或髂内动脉栓塞术，并撤出球囊导管。对照组64例采用传统剖宫产术。记录两组患者手术时间、术中失血量、24 h失血总量、术后住院时间及子宫切除率。

观察组104例剖宫产术前双侧髂内动脉预置球囊导管均获得成功，置入球囊导管过程中实际透视时间平均（74.2±14.3）s，X射线照射剂量平均（23.6±3.8）mGy。未发生下肢动脉血栓和髂内动脉动脉瘤等并发症。观察组手术时间低于对照组(min：75.8±19.5 vs. 136.8±27.6, t=10.382 )、术中失血量低于对照组[ml:1148.0(1142.8）vs. 3054.7(1644.7), Z=13.346]、24 h失血总量低于对照组[ml:1468.4（1236.4）vs. 4653.2(1725.1), Z=7.532]、术后住院时间少于对照组(d：6.9±1.6 vs. 10.2±1.7，t=4.681），差异均有统计学意义。观察组发生凝血功能异常、失血性休克、子宫切除的比例低于对照组，差异均有统计学意义（P<0.05），2组发生弥漫性血管内凝血和死亡的比例差异无统计学意义。观察组切除子宫的6例，均与胎盘植入广泛、胎盘穿透子宫肌层达浆膜层及胎盘无法剥离有关；对照组切除子宫的10例中7例与胎盘植入有关，3例与子宫收缩乏力有关。

剖宫产术前髂内动脉预置球囊，术中暂时阻断髂内动脉，术后栓塞双侧子宫动脉或髂内动脉的方法，能明显减少剖宫产术中及产后出血，降低子宫切除率，减少并发症的发生，是一种行之有效的方法。

To evaluate the clinical value of the preset internal iliac artery balloon catheter and postoperative embolization in treating patients with pernicious placenta previa undergoing caesaren section.

168 patients with pernicious placenta previa were selected, among which, 104, as the observation group, were preset with bilateral internal iliac artery balloon catheter, followed by cesarean section. After cesarean section, these women underwent bilateral internal iliac artery embolization. In another group, the remaining 64 patients received regular cesarean section as the control group. The clinical data of two groups , including the time for caesarean section, the amount of blood loss during operation, the amount of blood loss within 24 hours after operation, postoperative hospital stay and the hysterectomy rate were analyzed and compared.

In the observation group, all patients obtained satisfactory results. No serious complications, such as lower limb arterial thrombosis and the iliac artery aneurysm, occurred. The time for operation ranged at (75.8±19.5) min, the amount of blood loss during operation and within 24 hours reached to (1148.0±1142.8) ml, and (1468.4±1236.4) ml, respectively, the hospital stay after operation averaged at (6.9±1.6) days and the hysterectomy occurred in 6 patients (9.4%) . In the control group, the time for operation ranged at (136.8±27.6) min, the amount of blood loss during operation and within 24 hours reached to (3054.7±1644.7) ml, and (4653.2±1725.1) ml, respectively, the hospital stay after operation averaged at (10.2±1.7) days and the hysterectomy occurred in 10 patients (18%) with a significant statistical difference (P<0.05) . Among the 16 hysterectomy patients, 6 from the observation group were associated with placenta increta, and the placenta penetrating through myometrium to percreta, making it untearable, while in the .control group of 10 hysterectomies, 7 cases were associated with placenta increta, 3 associated with uterine contractions fatigue.

For patients with pernicious placenta previa, the temporary balloon occlusion of the internal iliac artery in cesarean section is a safe and effective technique, which can reduce the relative complications, such as the volume of bleeding and the risk of hysterectomy, thus, it can be used as a feasible method.