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·论著·子宫下段部分切除术在凶险性前置胎盘伴胎盘植入患者中的应用张胜坤，张艳玲 *，汤欣，沈 蓉，张晶波(东南大学医学院附属徐州医院 南京医科大学徐州临床医学院 徐州医科大学徐州临床学院徐州市中心医院妇产科，徐州 221009)【摘要】 目的:探讨子宫下段部分切除术在凶险性前置胎盘(PPP)伴胎盘植入中的临床疗效。方法:选取 2014 年 7 月至 2017 年 6 月徐州市中心医院妇产科收治的 PPP 伴胎盘植入患者 60 例，其中 30 例实施术前双侧髂内动脉球囊预置术 + 剖宫产术 + 子宫下段部分切除术(研究组)，30 例行常规治疗方案(术前髂内动脉球囊预置术 + 剖宫产术 +B-Lynch 缝合或子宫下段“8”字缝合、宫腔填塞、子宫动脉结扎等)(对照组)。比较两组的术中出血量、子宫切除率、手术时间、ICU 转入率、平均住院费用等。结果:研究组的术中出血量、子宫切除率、手术时间、ICU 转入率、平均住院费用等均小于对照组，差异有统计学意义(P＜0．05)。结论:子宫下段部分切除术在 PPP 伴胎盘植入的治疗中，可减少术中出血量、降低子宫切除风险及平均住院费用，具有一定优势。【关键词】 子宫下段;凶险性前置胎盘;胎盘植入中图分类号:Ｒ714．4 文献标志码:A 文章编号:1004－7379(2018)12－0921－03DOI:10．13283/j．cnki．xdfckjz．2018．12．009Clinical application of uterine lower segment local resection for pernicious placenta pre-via accreta with placenta implantation．Zhang Shengkun，Zhang Yanling，Tang Xin，et al．TheAffiliated Xuzhou Hospital of Medical Collage of Southeast University，Xuzhou Clinical School ofNanjing Medical University Xuzhou Clinical School of Xuzhou Medical University;Department ofGynecology and Obstetrics of Xuzhou Central Hospital，Xuzhou 221009【Abstract】 Objective:To explore the efficacy of uterine lower segment local resectionfor pernicious placenta previa accreta with placenta implantation．Methods:From July．2014 toJune．2017，60 cases from Xuzhou Central Hospital diagnosed with pernicious placenta previawere randomly divided into two groups:Ｒesearch group women received bilateral internal iliacarteries balloon occlusion before caesarean operation and uterine lower segment local resection．The control group was treated with bilateral internal iliac arteries balloon occlusion before cae-sarean operation and different kinds of conservative operations，including B-Lynch suture，loweruterine figure-of-eight sutures，intrauterine tamponade or uterine arteries ligation．Comparative a-nalysis was made between groups，concering blood loss during operation time，hysterectomyrate，ICU admission rate and hospitalization payment．Ｒesults:Compared to the control group，there was significant reduction in the research group concerning the blood loss during the opera-tion，operation time，hysterectomy rate，ICU admission rate，hospitalization payment(P＜0．05)．Conclusion:In the treatment of pernicious placenta previa accreta with placenta implantation，uterine lower segment local resection can reduce intraoperative hemorrhage，hysterectomy rateand hospitalization payment．【Key words】 Uterine lower segment;Pernicious placenta previa accreta;Placenta im-plantation1 2 9现代妇产科进展 2018 年 12 月第 27 卷第 12 期 Prog Obstet Gynecol，Dec．2018，Vol. 27，No. 12* 通讯作者 Email:xzzhangyanling@ 163．com