子宫动脉结扎术联合改良式子宫压缩缝合术在剖宫产产后出血中的应用

目的：观察子宫动脉结扎联合改良式B-lynch缝合术在剖宫产产后出血中的应用效果，并评价其临床应用价值。方法选择2013年1月至2014年12月在玉林市妇幼保健院的180例难治性产后出血产妇，将行子宫动脉结扎联合改良式B-lynch缝合术治疗的98例患者纳入观察组，将行子宫动脉结扎术的82例患者纳入对照组。比较两组患者的手术时间、产后出血量、产褥病率以及治疗效果。结果观察组患者的止血有效率为98.98%(97/98)，明显高于对照组的43.90%(36/82)，差异有统计学意义(P<0.05)；观察组术中出血量和术后24 h内出血量分别为(1051±449.86) ml和(68.95±27.20) ml，对照组则分别为(645.72±287.54) ml和(62.33±21.30) ml，两组比较差异均具有统计学意义(P<0.05)；观察组输血率为18.37%(18/98)，与对照组的9.76%(8/82)比较差异有统计学意义(P<0.05)；观察组手术操作时间为(79.83±21.96) min，明显长于对照组的(67.31±11.61) min，差异具有统计学意义(P<0.05)；两组患者产褥病率比较差异无统计学意义(P>0.05)。两组术后均无异常恶露，切口均为Ⅱ/甲愈合，未发生相关不良反应及严重并发症。结论子宫动脉结扎联合改良式B-lynch缝合术操作简便、止血效果良好，明显提高患者预后效果，提高了产科质量，可作为抢救剖宫产产后出血的手术措施之一，具有较好的应用前景。

Application of uterine artery ligation combined with modified suture in postpartum hemorrhage in cesarean ;section

Objective To observe the clinical effect of uterine artery ligation combined with modified B-lynch suture in postpartum hemorrhage. Methods A total of 180 patients with refractory postpartum hemorrhage in the Mater-nal and Child Health Care Hospital of Yulin from January 2013 to December 2014 were selected. Then, 98 patients treat-ed by uterine artery ligation combined with modified B-lynch suture were enrolled as the observation group, and 82 pa-tients treated with uterine artery ligation were included in the control group. The operation time, the amount of bleeding, puerperal morbidity and therapeutic effect were compared between the two groups. Results The effective rate of hemo-stasis in the observation group was 98.98%(97/98), significantly higher than that of the control group (43.90%, 36/82), and the difference was statistically significant (P<0.05). The amount of bleeding during operation and the amount of bleeding within 24 hours were (1 051 ± 449.86) ml and (68.95 ± 27.20) ml in the observation group, (645.72 ± 287.54) ml and (62.33±21.30) ml in the control group, with significant difference between the two groups (P<0.05). The blood trans-fusion rate was 18.37%(18/98) in the observation group and 9.76%(8/82) in the control group, with significant differ-ence between the two groups (P<0.05). The operation time of the observation group was (79.83±21.96) min, significant-ly longer than (67.31±11.61) min in the control group (P<0.05). No significant differences was found in puerperal mor-bidity between the two groups (P>0.05). Two groups of patients had no abnormal lochia, adverse reaction and complica-tion, and the incision was healingⅡ/A. Conclusion Uterine artery ligation combined with modified B-lynch suture is of simple operation and good hemostatic effect, which can significantly improve the prognosis and the quality of obstet-ric surgery. It can be used as one of the measures to treat postpartum hemorrhage, and is worth of clinical promoting.