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目的探讨输尿管置管在凶险型前置胎盘(PPP)孕妇剖宫产子宫切除术中应用的安全性和可行性。方法选择7例术前行双侧输尿管置管的PPP且因术中大出血而行子宫切除的患者为研究组,同期因产时大出血但未行输尿管置管而行子宫切除的PPP产妇14例为对照组,比较两组手术时间、术中及24小时出血总量、术中泌尿系统损伤情况、大量输血发生率、术后转ICU、分娩后住院天数、术后并发症等。结果研究组手术时间(206.43±48.86)min,对照组手术时间(250.71±39.43)min,对照组输尿管损伤1例,两组产妇分娩后住院天数差异有统计学意义(P<0.05)。研究组术中出血量、24h出血总量、输血量、术后并发症发生率均小于对照组,但差异无统计学意义(P>0.05)。结论在凶险型前置胎盘剖宫产子宫切除术前预防性输尿管置管可降低泌尿系统损伤的风险、缩短手术时间与分娩后住院天数,膀胱镜检查可作为诊断胎盘植入膀胱检查的补充。
Objective To investigate the safety and feasibility of ureteral catheterization in cesarean section hysterectomy for dangerous placenta previa (PPP). Methods Seven patients with PPP underwent ureteral catheterization undergoing preoperative urethral catheterization and hysterectomy due to intraoperative hemorrhage were selected as the study group. During the same period, 14 maternal PPP patients undergoing hysterectomy due to massive intrapartum bleeding without catheterization were Control group, the operation time, intraoperative and 24-hour total bleeding, intraoperative urinary tract injury, the incidence of massive transfusion, postoperative transfer to ICU, postpartum hospitalization days, postoperative complications and so on. Results The operation time (206.43 ± 48.86) min in the study group, operation time in the control group (250.71 ± 39.43) min, and ureter injury in the control group was 1 case. There was significant difference in the number of hospitalizations between the two groups after delivery (P <0.05). The bleeding volume, the total amount of bleeding in 24h, the volume of blood transfusion and the incidence of postoperative complications in the study group were all less than those in the control group, but the difference was not statistically significant (P> 0.05). Conclusions Preventive ureteral catheterization in cesarean section of threatened placenta previa can reduce the risk of urinary tract injury and shorten the operation time and hospital stay after delivery. Cystoscopy can be used as a supplement to diagnose placenta accreta bladder.