PDF(Pubmed)
Abstract：
Background: Placenta accreta spectrum (PAS) can be the cause of major morbidity and its optimal management is still controversial. The aim of this study was to compare the traditional one-step surgery with a two-step surgical approach in which the placenta is left in situ and the second final operation is delayed to minimise blood loss. Methods: We conducted a single-centre retrospective cohort study including all patients managed for PAS between 2007 and 2023. The number of units of red blood cells (RBCs) needed during surgery was the primary outcome used to compare these two approaches. Results: A total of 43 cases were included in this analysis. Twenty of these were managed with the delayed two-step surgical approach, whereas 23 received one-step surgery. The median estimated blood loss during surgery was 2000 mL and 2800 mL for two-step and one-step surgery, respectively (p = 0.095). In the two-step surgical approach, the median number of RBC units transfused during surgery was significantly lower (p = 0.049) and the odds ratio for needing more than four units of RBCs was 0.28 (95%-CI: 0.08-0.98, p = 0.043). A longer interval between the caesarean section and the second operation showed a trend toward lower blood loss (p = 0.065) and was associated with a significantly lower number of RBC units needed during surgery (p = 0.019). Conclusions: Two-step surgery for the treatment of PAS was safe in our cohort and could lead to a reduction in blood transfusion. Leaving the placenta in situ and delaying the final operation represents a possible alternative to traditional caesarean hysterectomy.
摘要：
背景：胎盘植入谱（PAS）可能是主要发病的原因，其最佳管理仍存在争议。这项研究的目的是将传统的一步手术与两步手术方法进行比较，在两步手术方法中，胎盘留在原位，并延迟第二次最终手术以最大程度地减少失血。方法：我们进行了一项单中心回顾性队列研究，包括2007年至2023年接受PAS治疗的所有患者。手术期间所需的红细胞（RBC）单位数是比较这两种方法的主要结果。结果:共纳入43例病例。其中20例采用延迟的两步手术方法进行了治疗，而23人接受了一步手术。两步和一步手术的术中估计失血中位数为2000毫升和2800毫升，分别(p=0.095)。在两步手术方法中，手术期间输注的红细胞单位的中位数显著较低(p=0.049),需要4个以上红细胞单位的比值比为0.28(95%-CI:0.08~0.98,p=0.043).剖腹产和第二次手术之间的间隔较长，显示出减少失血的趋势（p=0.065），并且与手术期间所需的RBC单位数量显着减少有关（p=0.019）。结论：在我们的队列中，两步手术治疗PAS是安全的，并且可能导致输血减少。将胎盘留在原位并延迟最终手术是传统剖宫产子宫切除术的可能替代方法。
