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目的探索正常状态下X线引导与非正常状态下无X线引导定位植入球囊临时低位阻断腹主动脉,辅助凶险性前置胎盘(PPP)剖宫产术的临床应用效果及安全性。方法将术前诊断PPP 67例,分A组14例为不接受X线照射但接受球囊阻断的孕妇,无X线引导定位、利用解剖标志和手法定位实施球囊植入行腹主动脉低位阻断辅助剖宫产手术;B组19例为既不接受X线照射也不接受球囊阻断的孕妇直接实施剖宫产术;C组34例为术前同意接受X线导向下预置球囊阻断辅助剖宫产手术。观察疗效及并发症。结果术中出血量A组约200~900ml,平均(670±247)ml,B组约900~4 900ml,平均(2850±720)ml,C组约200~1 100ml,平均(630±261)ml;术后仍出血加行子宫动脉栓塞术:A组7例,B组12例,C组16例;子宫切除:A组0例,B组4例,C组0例。腹主动脉低位阻断术全部成功,随访期无并发症。结论腹主动脉球囊低位阻断辅助剖宫产手术是有效的,对手术有帮助,可降低子宫切除风险,对非正常状态下无X线引导定位实施球囊植入需有丰富导管导丝操作经验和手感知能力的医师尝试、有一定的可行性,但尚存在隐性风险可能。
Objective To explore the clinical effect and safety of X-ray guided and non-normal guided X-ray guided positioning balloon at temporary low level to block the abdominal aorta in order to assist cesarean section of dangerous placenta previa (PPP) . Methods Sixty-seven patients were randomly divided into group A (n = 14) and type A (n = 14) .All the patients were randomly divided into group A (n = 14) Low blockade assisted cesarean section; group B, 19 cases of cesarean section were performed in pregnant women who neither received X-ray irradiation nor balloon occlusion; 34 cases in group C received preoperative X-ray guidance Placement of balloon-assisted cesarean section. Observation of efficacy and complications. Results The intraoperative blood loss was about 200-900 ml in group A, with an average of (670 ± 247) ml in group A, about 900-4,900 ml in group B (2850 ± 720) ml on average, and about 200-1 100 ml in group C (mean, 630 ± 261) ml; postoperative hemorrhage plus uterine artery embolization: A group of 7 cases, B group of 12 cases, C group of 16 cases; hysterectomy: A group of 0 cases, B group 4 cases, C group 0 cases. Abdominal aorta low block all successful, no complications during follow-up. Conclusion Abdominal aorta balloon assisted occlusion assisted cesarean section is effective, which is helpful for surgery and can reduce the risk of hysterectomy. Abnormal X-ray guidance and positioning balloon implantation is required to have rich catheter guide wire Operation experience and hand perception of the physician try to have a certain feasibility, but there are still hidden risks may be.