探讨宫颈内口成形术治疗完全性前置胎盘伴胎盘植入孕妇剖宫产术分娩大出血的有效性和安全性。

选择2012年1月至2018年5月，在四川大学华西第二医院确诊为完全性前置胎盘伴胎盘植入，并且在剖宫产术分娩中采用宫颈内口成形术进行止血的56例孕妇为研究对象，纳入研究组。按照随机数字表法，随机抽取同期在本院因完全性前置胎盘伴胎盘植入进行剖宫产术分娩，并且于术中采用其他缝合止血技术进行止血的60例孕妇纳入对照组。回顾性分析2组孕妇围手术期结局指标，其中2组孕妇产后大出血率、术中输血率、止血治疗有效率等比较，采用χ²检验；2组孕妇手术时间、术后住院时间及住院费用等比较，采用成组t检验。本研究遵循的程序符合四川大学华西第二医院人体试验委员会所制定的伦理学标准，并得到该委员会批准[审批文号：(2014)伦审批第(27)号]。

①2组孕妇年龄、孕次、产次、孕龄及剖宫产术分娩史、既往宫腔操作史和急诊剖宫产术分娩者所占比例等一般临床资料比较，差异均无统计学意义(P>0.05)。②研究组孕妇止血治疗有效率为92.9%(52/56)，明显高于对照组的73.3%(44/60)，2组比较，差异有统计学意义(χ²＝8.773，P＝0.003)。③研究组与对照组孕妇产后大出血率、术中输血率、手术时间、术后住院时间、住院费用分别为41.1%(23/56)与43.3%(26/60)、28.6%(16/56)与25.0%(15/60)、(66.7±22.5)min与(69.5±22.0)min、(4.6±1.1) d与(5.1±1.6) d、(2.09±0.09)万元与(2.22±0.11)万元，2组上述指标分别比较，差异均无统计学意义(χ²＝0.062，P＝0.805；χ²＝0.194，P＝0.661；t＝0.661，P＝0.510；t＝1.852，P＝0.067；t＝0.935，P＝0.356)。2组孕妇无一例发生手术及大出血相关并发症。

采用宫颈内口成形术，对完全性前置胎盘伴胎盘植入孕妇剖宫产术分娩大出血进行止血治疗，安全、有效。因本研究仅为回顾性研究，该技术在临床推广应用价值，还需要大样本、多中心、随机对照研究结果证实。

To investigate the effectiveness and safety of cervical internal os plasty in treating hemorrhea during cesarean section of pregnant women with complete placenta previa and placenta accreta.

From January 2012 to May 2018, a total of 56 pregnant women who were diagnosed as complete placenta previa with placenta accreta in West China Second University Hospital, Sichuan University and underwent cervical internal os plasty for hemostasis during cesarean section were selected as research subjects and included in study group. According to the random number table method, another 60 pregnant women who were delivered by cesarean section due to complete placenta previa with placenta accreta and received other suture hemostasis techniques during the same period in the same hospital were randomly selected and included in control group. The perioperative outcomes of two groups were retrospectively analyzed and compared. And chi-square test was used to compare postpartum hemorrhage rate, intraoperative blood transfusion rate and effective rate of hemostasis between two groups. Independent-samples t test was used to compare the operation duration, length of stay after operation and hospitalization expenses between two groups. The procedure of this study was consistent with ethical standard established by the committee of investigation in human beings of West China Second University Hospital, Sichuan University [Approval No. 2014(27)].

①There were no significant differences between two groups in age, gravidity, parity, gestational age, and the proportion of cesarean section history, previous uterine cavity operation history and emergency cesarean section (P>0.05). ②The effective rate of hemostasis in study group was 92.9% (52/56), which was significantly higher than 73.3% (44/60) in control group, and the difference between two groups was statistically significant (χ²=8.773, P=0.003). ③The postpartum hemorrhage rate, intraoperative blood transfusion rate, operation duration, length of stay after operation and hospitalization expenses in study group were 41.1% (23/56), 28.6% (16/56), (66.7±22.5) min, (4.6±1.1) d and (2.09±0.09) × 10⁴ yuan, respectively, and these five indexes were 43.3% (26/60), 25.0% (15/60), (69.5±22.0) min, (5.1±1.6) d and (2.22±0.11) × 10⁴ yuan, respectively in control group, and all the differences between two groups were not statistically significant (χ²=0.062, P=0.805; χ²=0.194, P=0.661; t=0.661, P=0.510; t=1.852, P=0.067; t=0.935, P=0.356). No complications related to surgery or massive hemorrhage occurred in two groups.

Cervical internal os plasty is a safe and effective hemostatic technique in cesarean section for pregnant women with complete placenta previa and placenta accreta. As the sample size of this study is relatively small, whether this hemostatic technique is worthy of clinical application or not, it still needs to be confirmed by large-sample, multi-center and randomized controlled studies.