Operations Analyzation Of 187 Patients And The Study Of 28 Cases With Low Position Uterine Artery Ligation In Cesarean Section Of Pernicious Placenta Previa Without Balloon Occlusion Of The Abdominal Aorta Or Internal Iliac Artery

Objective:To analyze the postoperative outcomes of the pernicious placenta previa with non-vascular sac preset under non-interventional conditions,and to summarize the safety of combining multiple surgical methods and low position uterine artery ligation during the cesarean section of the dangerous placenta previa.,Effectiveness and practicality.Methods:A retrospective analysis of 187 cases of caesarean section performed in the Department of Obstetrics and Gynecology,Affiliated Hospital of North Sichuan Medical College from June 1,2014 to May 31,2019(with additional surgical procedures,Blood loss,ransfusion rate,para-injury,hysterectomy,mortality,and other surgical outcomes);and analysis of 28 cases of minimally uterine arterial ligation performed during the cesarean section of placenta previa after December 2017 Group,31 patients with the same medical group who had not undergone uterine artery ligation before December 2017 were selected as the control group.The intraoperative blood loss,intraoperative blood transfusion rate,blood transfusion volume,preoperative and postoperative hemoglobin difference,and hysterectomy were analyzed.Rate,postoperative bleeding volume,postoperative hospital stay,postoperative quality of life score,postoperative uterine function evaluation and uterine vascular examination in patients with uterine artery ligation:uterine preservation for menstrual rejuvenation time,partial uterine blood vessel ligation for uterine enhancement Patients with magnetic resonance imaging(MRI)and uterine artery ligation underwent CT angiography(CTA)of the uterine artery,and the conditions of the two groups were compared.Results:1)In the past 5 years,187 patients with multiple surgical procedures for the treatment of Pernicious placenta previa did not die.Of these,15 were hysterectomy(8.02%),and 30 patients(16.04%)were admitted to the ICU after surgery.The number of patients was P50=1300ml(600ml～5000ml),and the overall blood transfusion rate was 75.94%(142 cases).All patients used local suture of the uterine body,modified B-Lynch suture,cervical suture,CHO four-sided suture,and uterine cavity.Surgery such as balloon compression and minimal uterine artery ligation can complete the operation;2)There was no significant difference in the operation time,intraoperative blood transfusion rate,and hysterectomy rate between the two groups of patients undergoing uterine artery ligation and those without uterine artery ligation(P>0.05).The patient’s intraoperative blood loss(1228.57±638.20 ml vs 1593.55± 685.05 ml),the difference in hemoglobin before and after surgery(10.50 ± 8.45 g/liter vs 16.23± 11.83 g/liter),and the blood transfusion volume(583.57± 585.35 ml vs790.32± 809.26 ml),the difference was statistically significant(P<0.05).There was no statistical difference in the length of hospital stay,postmenstrual rejuvenation time,and quality of life scores between the two groups after surgery(P>0.05).Contrast-enhanced MRI in some patients with arterial ligation showed no abnormal signal intensity on both sides,and there was no abnormality in CTA during follow-up.There was no significant difference in the situation of newborns between the two groups(P>0.05).No patients died in either group.One patient in the observation group underwent hysterectomy,and four patients in the control group underwent hysterectomy.There were no unplanned reoperations and ureteral damage to peripheral organs.Conclusion:1)Pernicious placenta previa has lots of bleeding and is more difficult to operate.It is feasible to use multiple suture hemostasis and multidisciplinary teamwork in the operation of placenta previa cesarean section without balloon occlusion of the abdominal aorta or internal iliac artery.Our surgeries and The domestic part of the pernicious placenta previa surgery with vascular balloon occlusion has similar treatment effect,and there are no complications of vascular balloon occlusion.2)In the pernicious placenta previa cesarean section without vascular balloon occlusion,it needs to be combined with uterine artery ligation,local wound suture,B-Lynch suture,cervical pull-up suture,uterine balloon compression The operation can complete the operation;3)low position uterine artery ligation avoids the ureter next to the uterine artery,and simultaneously ligates the upper and lower branches of the uterine artery.This operation has the characteristics of reducing bleeding,simple and fast operation,and not significantly increasing the operation time.It is safe and effective in uterine delivery;4)Observation of ROI of uterine body muscle layer and uterine artery angiography(CTA)with enhanced magnetic resonance(MRI)postoperatively can be used for uterine function and blood vessel evaluation after low position uterine artery ligation,but the number of examination cases is small and needs further research.