mvjrМедицинский вестник Юга РоссииMedical Herald of the South of Russia2219-80752618-7876The Rostov State Medical University10.21886/2219-8075-2022-13-3-161-172mvjr-1552Research ArticleАКУШЕРСТВО И ГИНЕКОЛОГИЯOBSTETRICS AND GYNECOLOGYСравнительный анализ эффективности различных методов хирургического гемостаза у пациенток с врастанием плацентыComparative analysis of the effectiveness of different methods of surgical hemostasis in patients with placenta accreta spectrum disordershttps://orcid.org/0000-0003-2228-3884ЦхайВ. Б.TskhayV. B.

Цхай Виталий Борисович – доктор медицинских наук, профессор, заведующий кафедрой перинатологии, акушерства и гинекологии лечебного факультета.

Красноярск.

Vitalу B. Tskhay - Dr. Sci. (Med.), Professor, Head of the Department of Perinatology, Obstetrics and Gynecology, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University.

Krasnoyarsk.

tchai@yandex.ruБакунинаА. А.BakuninaA. A.

Бакунина Анна Александровна - клинический ординатор кафедры перинатологии, акушерства и гинекологии лечебного факультета.

Красноярск.

Anna A. Bakunina - resident of the Department of Perinatology, Obstetrics and Gynecology, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University.

Krasnoyarsk.

b_anna02@mail.ruКрасноярский государственный медицинский университет им. проф. В.Ф. Войно-ЯсенецкогоРоссияProf. V.F. Voyno-Yasenetskiy Krasnoyarsk State Medical UniversityRussian Federation202230092022133161172Copyright © Цхай В.Б., Бакунина А.А., 20222022Цхай В.Б., Бакунина А.А.Tskhay V.B., Bakunina A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medicalherald.ru/jour/article/view/1552

В настоящее время медицинским сообществом накоплен значительный опыт применения в акушерской практике эндоваскулярных методов для достижения гемостаза и предотвращения массивного кровотечения, в том числе у пациенток с нарушениями спектра приращения плаценты (PAS). Цель — оценить эффективность различных методов деваскуляризации матки в снижении кровопотери во время операции кесарева сечения у пациенток с PAS. Проведены анализ соответствующей литературы и оценка качества клинических исследований на основе систематического поиска в базах данных Embase, PubMed, Web of Science и Cochrane Library. В статье представлен обзор современных методов деваскуляризации матки, направленных на снижение интраоперационной кровопотери у пациенток с PAS. Проведён сравнительный анализ эффективности таких методов деваскуляризации матки, как временная баллонная окклюзия внутренних подвздошных артерий, общих подвздошных артерий, брюшного отдела аорты, а также артериальной компрессии при помощи дистального гемостаза. Эффективность методов оценена по таким показателям, как средняя величина кровопотери и частота гистерэктомий. Наиболее эффективными методами гемостаза у пациенток с PAS являются временная баллонная окклюзия брюшного отдела аорты и отечественный метод дистального гемостаза. В то же время до сих пор не существует идеального метода деваскуляризации матки при PAS и клинические исследования в этом направлении следует продолжить.

Currently, the medical community has accumulated significant experience in the use of endovascular methods in obstetric practice to achieve hemostasis and prevent massive hemorrhage, including in patients with placenta accreta spectrum (PAS) disorders. Objective — to evaluate the effectiveness of various methods of uterine devascularization in reducing blood loss during caesarean section in patients with PAS. In this review, we analyzed relevant literature and assessed the quality of clinical trials based on a systematic search in the Embase, PubMed, Web of Science, and Cochrane Library databases. The review presents an overview of modern methods of uterine devascularization aimed at reducing intraoperative blood loss in patients with PAS. A comparative analysis of the effectiveness of such methods of uterine devascularization as temporary balloon occlusion of the internal iliac arteries, common iliac arteries, abdominal aorta, as well as arterial compression using distal hemostasis was carried out. We evaluated effectiveness of the methods by such indicators as the mean amount of blood loss and the frequency of hysterectomy. The most effective methods of hemostasis in patients with PAS are temporary balloon occlusion of the abdominal aorta and the method of distal hemostasis. At the same time, there is still no ideal method for uterine devascularization in PAS, and clinical research in this direction should be continued.

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The authors declare that there are no conflicts of interest present.