Non-conservative Management of Placenta Accreta Spectrum in the Hybrid Operating Room: A Retrospective Cohort Study
Non-conservative Management of Placenta Accreta Spectrum in the Hybrid Operating Room: A Retrospective Cohort Study
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DOI：
10.1007/s00270-018-2113-y
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发表时间：
2019-03-01
影响因子：
2.9
通讯作者：
Otano, Lucas
中科院分区：
文献类型：
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作者：
Hernan Meller, Cesar;Garcia-Monaco, Ricardo D.;Otano, Lucas
前言子宫切除术是胎盘植入的标准治疗方法。为了降低手术期间产科出血的风险，已经提出了血管内介入治疗。我们的目的是评估的可行性和安全性的整体非保守管理PAS在混合手术室（OR），以取代经典的两步程序（导管插入在介入放射学套件和转移到传统OR）。Materials and MethodsThis是一个回顾性研究的一系列患者的组织病理学证实PAS在混合OR在同一所大学医院治疗。我们用于比较我们的历史队列管理与标准的两步procedure.ResultsWe包括110例患者，80在传统的OR和30在混合OR。没有可归因于血管内手术的重大并发症病例。在两步手术中，有10例（12.5%）动脉内导管移位需要在传统OR中在移动的C形臂荧光透视下重新定位，混合OR中没有病例（p=0.04）。传统OR的平均手术时间为380 ± 42分钟，混合OR为296 ± 66分钟（p=.00001）。在分娩时的胎龄、术后住院时间或大量输血方面没有差异。有没有孕产妇deaths.ConclusionsThe整体非保守管理PAS在混合OR已被证明是可行的，安全的，在我们的系列，提供潜在的优势，以取代经典的两步程序。需要更多的研究来评估这种策略是否具有成本效益，以及它是否可以改善孕产妇和围产期结局。
IntroductionHysterectomy is the standard of care in placenta accreta spectrum (PAS). To reduce the risks of obstetric hemorrhage during surgery, endovascular interventions have been proposed. Our aim is to evaluate the feasibility and safety of the overall non-conservative management of PAS in the hybrid operating room (OR) to replace the classic two-step procedure (catheterization in the interventional radiology suite and transfer to conventional OR).Materials and MethodsThis is a retrospective study of series of patients with histopathologic confirmation of PAS treated in the hybrid OR at the same university hospital. We used for comparison our historical cohort managed with the standard two-step procedure.ResultsWe included 110 patients, 80 in the conventional OR and 30 in the hybrid OR. There were no cases of major complications attributable to the endovascular procedures. In the two-step procedure, there were 10 (12.5%) intra-arterial catheter displacements that required repositioning in the conventional OR under mobile C-arm fluoroscopy and no cases in the hybrid OR (p=0.04). The mean operative time was 380+42min in the conventional OR and 296+66min in the hybrid OR (p=.00001). There were no differences in the gestational age at delivery, postoperative length of stay, or large-volume blood transfusion. There were no maternal deaths.ConclusionsThe overall non-conservative management of PAS in the hybrid OR has shown to be feasible and safe in our series, offering potential advantages to replace the classic two-step procedure. More studies are needed to evaluate whether this strategy is cost-effective and whether it may improve maternal and perinatal outcomes.