子宫交叉捆绑术治疗剖宫产术中难治性产后出血疗效研究

摘要

Objective To evaluate the safety and efficacy of cross binding suture in controlling refractory postpartum hemorrhage during cesarean section.Methods Clinical data of 57 women with intractable postpartum hemorrhage treated with uterine compression suture in obstetrical department of the hospital from October 2010 to September 2013 were analyzed retrospectively,then the women were divided into cross binding group (including 35 women) and B-Lynch group (including 22 women);the intraoperative,postoperative 2-hour volume of hemorrhage and postoperative 24-hour volume of hemorrhage,average hospitalization time,postoperative complications and recovery conditions in the two groups were compared.Results The hemostatic effective rates in cross binding group and B-Lynch group were 97％ and 86％,respectively,there being statistically significant difference between the two groups (P ＜ 0.05).There were statistically significant differences in the intraoperative and postoperative 2-hour amounts of hemorrhage and postoperative 24-hour volume of hemorrhage and average hospitalization time between the two groups (P ＜ 0.05).No complication occurred in cross binding suture group,while one woman with uterine adhesion was found in B-Lynch group.Subsequent pregnancies after the cross binding suture occurred in two women who underwent repeat caesarean delivery during our follow-up period,while there was no pregnancy in B-Lynch suture.Conclusion Cross binding uterine suture is a safe and effective surgical treatment for postpartum hemorrhage,and it has the advantage of little injury to uteri and fewer complications,which is worth further popularizing in clinics.%目的 探讨子宫交叉捆绑术治疗剖宫产术中难治性产后出血的有效性与安全性.方法 回顾性分析重庆医科大学附属第一医院产科2010年10月至2013年9月应用子宫捆绑缝合术治疗的57例剖宫产术中难治性产后出血病例资料,根据缝合方法分为子宫交叉捆绑术组(n=35)与B-Lynch缝合术组(n=22),比较两组术中、术后2h、术后24h出血量以及住院天数、术后并发症及随访情况.结果 (1)交叉捆绑术组止血有效率97％,B-Lynch缝合术组为86％,两组比较差异有统计学意义(P＜0.05).(2)两组术中、术后2h、术后24h出血量及住院天数比较差异均有统计学意义(P＜0.05).(3)交叉捆绑术后随访现未发现并发症,B-Lynch缝合术后有1例发生宫腔粘连.(4)交叉捆绑术组术后随访期间有2例正常妊娠,B-Lynch缝合术组术后随访未发现再次妊娠的病例.结论 剖宫产术中施行子宫交叉捆绑术是一种有效且安全的治疗剖宫产术中难治性产后出血的方法,而且其并发症少,对子宫的损伤小,值得临床推广应用.