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目的:比较择期手术和急诊手术对胎盘植入患者的临床疗效及围手术期结局的影响。方法:选择2010年8月~2013年7月南京医科大学第一附属医院产科收治的58例剖宫产终止妊娠的胎盘植入患者,按照手术时机分为择期手术(22例)和急诊手术(36例)两组,对比两组患者的手术疗效及不同手术时机对妊娠结局的影响。结果:择期手术组患者产后24 h出血量显著低于急诊手术组(t=3.524,P<0.05),并且择期手术组患者入住重症监护室发生率也明显低于急诊手术组(χ2=4.203,P<0.05);而择期手术组患者泌尿系统损伤、子宫切除及二次手术的发生率与急诊手术组相比差异无统计学意义(P>0.05)。此外,择期手术组患者产褥感染率、晚期产后出血率、β-hCG降至正常时间以及胎盘完全排出时间与急诊手术患者相比差异无统计学意义(P>0.05)。结论:择期手术能有效降低胎盘植入患者产后出血量及患者入住重症监护室的发生率;手术时机的选择需要结合患者的孕周、术前诊断及出血情况等进行综合评估。
Objective: To compare the clinical efficacy and perioperative outcome of elective surgery and emergency surgery in patients with placenta accreta. Methods: From August 2010 to July 2013, 58 cases of cesarean section termination of pregnancy were admitted to the First Affiliated Hospital of Nanjing Medical University. Patients were divided into elective surgery (22 cases) and emergency operation 36 cases) were divided into two groups. The curative effect of two groups of patients and the effect of different operation timing on pregnancy outcome were compared. Results: The amount of bleeding at 24 hours postpartum in elective surgery group was significantly lower than that in emergency surgery group (t = 3.524, P <0.05), and the incidence of intensive care unit in elective surgery group was significantly lower than that of emergency surgery group (χ2 = 4.203, P <0.05). However, the incidence of urinary tract injury, hysterectomy and secondary surgery in elective surgery group was not significantly different from that in emergency surgery group (P> 0.05). In addition, the rate of puerperal infection, late postpartum hemorrhage, β-hCG down to normal time, and complete placental discharge time in elective surgery group were not significantly different from those in emergency surgery group (P> 0.05). Conclusion: Elective surgery can effectively reduce the amount of postpartum hemorrhage and the incidence of patients admitted to intensive care unit after placenta accreta. The timing of operation needs to be comprehensively evaluated in combination with gestational age, preoperative diagnosis and bleeding.