(4)当センターで経験した前置癒着胎盤症例における術中出血量低減に関する手術手技の臨床的検討 : 従来法の有用性に関する検討と総腸骨動脈Balloon Occlusionを併用したCesarean Hysterectomyの有用性に関する検討(シンポジウム1「産科出血と胎盤異常」,第61回日本産婦人科学会・学術講演会)

概要

論文の詳細を見る
Life threatening hemorrhage often occurs in patients with placenta previa accreta. We retrospectively reviewed 25 cases of placenta previa accreta receiving cesarean hysterectomy during the period of 1985 to 2006 in the Saitama Medical Center. The mean blood loss was significantly increased in the patients who underwent manual removal of the placenta during cesarean section (p<0.05). In 17 of the 25 cases, ligations of the bilateral internal iliac arteries (IIAL) were performed before hysterectomy. The mean blood loss during cesarean hysterectomy was not different with or without IIAL. We recognized abundant anastomotic collaterals from the common iliac arteries and the external iliac arteries in some cases. From 2006, we employed the preoperative placement of occlusive balloon catheters in the bilateral common iliac arteries (CIABO) in 14 cases of placenta previa accreta. CIABO effectively reduced the mean blood loss during cesarean hysterectomy in comparison to the 17 cases performed cesarean hysterectomy with IIAL (p<0.01) and the 8 cases without IIAL (p=0.01). Severe complications like arterial embolism or crush syndrome were not observed in patients with CIABO.
社団法人日本産科婦人科学会の論文
2009-12-01