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目的探讨双侧股动脉预置管联合剖宫产即刻动脉栓塞治疗凶险型前置胎盘合并胎盘植入的临床效果。方法对9例凶险型前置胎盘合并胎盘植入的患者,在无射线透视下行双侧股动脉置管,继而行剖宫产,取出胎儿后如证实胎盘植入子宫肌层,立即行动脉栓塞,栓塞成功后,钝锐性结合再行胎盘剥离,术后辅以甲氨蝶呤(Methotrexate,MTX)治疗。同时随访B超及血B-人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)水平。结果 9例患者皆栓塞成功,在确保产妇生命安全的前提下,均成功保全子宫。术后检查血B-HCG恢复正常,子宫B超未见异常。9例患者均恢复正常月经来潮。结论双侧股动脉预置管联合剖宫产即刻动脉栓塞治疗为凶险型前置胎盘合并胎盘植入患者最大限度的减少出血并保全子宫提供了一种安全的新选择。
Objective To investigate the clinical effect of bilateral femoral artery preconditioning combined with cesarean section immediate arterial embolization in the treatment of dangerous placenta previa combined placenta accreta. Methods Nine patients with malignant placenta previa and placenta accreta were treated with bilateral femoral artery catheterization without radiography and cesarean section followed by placenta accreta. After successful embolization, blunt sharp combined with placental detachment followed by methotrexate (MTX) treatment. At the same time, the levels of B-ultrasound and B-human chorionic gonadotrophin (HCG) were followed up. Results Nine patients were successfully embolized, and the uterus was successfully preserved under the premise of ensuring the life safety of the woman. Postoperative blood B-HCG returned to normal, no abnormalities in the uterine B-ultrasound. All 9 patients returned to normal menstrual cramps. Conclusions Bilateral femoral artery catheterization combined with cesarean section immediate arterial embolization provides a safe new option for patients with aggressive placenta previa and placenta accreta to minimize bleeding and preserve the uterus.