改良B-Lynch缝合术在产后出血中的应用

目的:探讨改良B-Lynch缝合术治疗产后出血的可行性及效果.方法:回顾性分析我院2006年1月至2008年12月17例产后出血及可能出血的患者施行改良B-Lynch缝合术的方法及效果.结果:对15例剖宫产出血患者及2例经阴道分娩后产后出血患者实行改良B-Lynch缝合术,所有病例止血效果满意,无晚期产后出血,预防和治疗产后出血效果较好,且子宫复旧及月经恢复情况均正常.结论:改良B-Lynch缝合术操作简单、安全,在预防和治疗产后出血,尤其是在剖宫产术中子宫收缩乏力及其他原因所致的子宫弥漫性出血方面,效果确切,是一种有效的可避免子宫切除的高效的外科止血方法.     

改良式B-Lynch缝合术在剖宫产产后出血中的运用

目的:探讨改良式B-Lynch缝合术在治疗剖宫产产后出血中的应用价值.方法:对20例因剖宫产术中宫缩乏力性出血的病例采用改良式B-Lynch缝合术治疗,观察其止血效果.结果:20例治疗后宫缩好转,出血减少,无继发产后出血,成功地保留了子宫,术后无任何并发症发生.结论:改良式B-Lynch缝合术具有操作简单、止血迅速可靠、且能保留子宫等优点,是治疗剖宫产产后出血行之有效的止血方法.     

改良B-Lynch缝合术在产后出血中的应用

产后出血是分娩期的严重并发症，目前仍然是我国孕产妇死亡的首要原因。近年来我国剖宫产率明显上升，剖宫产中大出血的发生例数也相应增多。处理产后出血的方法虽多，但各种方法可在不同条件下起作用，同时有一定的失败率或并发症。我院自2002年1月～2005年5月采用改良B-Lynch缝合术成功治疗30例子宫收缩乏力性出血，现报道如下。     

应用B-Lynch缝合术预防剖宫产产后出血临床观察报告

目的:探讨子宫B-Lynch缝合术对预防有高危因素存在时剖宫产后出血的作用。方法:选择2008年1月至2010年1月在我院行剖宫产、有产后出血高危因素存在的患者共60例,随机分为治疗组30例及对照组30例。治疗组在术中同时行预防性子宫B-Lynch缝合,对照组未行预防性子宫B-Lynch缝合术。比较两组的手术时间、产后出血量、子宫切除例数等。结果:治疗组手术时间长于对照组,但产后出血量、子宫切除例数明显低于对照组。结论:子宫B-Lynch缝合术可用于预防有高危因素存在的剖宫产后出血,且不增加患者住院费用。     

改良B-Lynch缝合术处理剖宫产术中宫缩乏力性产后出血

剖宫产术中宫缩乏力性产后出血是产科常见的并发症之一。改良B—Lynch缝合术是处理方法之一。我们用改良B—Lynch缝合术处理剖宫术中宫缩乏力性产后出血26例，25例避免了子宫切除，有效率达96．2％。现报告如下。     

产后出血改良B-Lynch缝合术102例分析及随访结局北大核心CSCD

目的探讨改良B-Lynch子宫缝合术对中期生殖健康影响。方法采用随访登记系统对北京市上地医院2008年3月至2017年6月因产后出血行B-Lynch术的102例患者进行了调查,主要观察指标是患者再次成功受孕次数,次要监测指标是初次和再次产后的出血量、输血量等。结果 102例患者共做了104次改良B-Lynch术。全部患者平均随访37个月,期间再次受孕或分娩23例,再孕率达34.4%;而改良B-Lynch术后再次产后患者的平均术中出血量、输血量等明显高于初次者;Logistic回归分析表明改良B-Lynch术后再次产后患者的术中出血量、DIC和产褥病率等观察指标与再次生育有关,是产后出血的高危因素。结论改良B-Lynch术后患者生殖健康状况良好,但应注意再次产后子宫出血、DIC和产褥病率等的发生。     

低位B-Lynch缝合术治疗难治性前置胎盘性产后出血

B-Lynch子宫缝合法为一种治疗产后出血的保守性手术，操作简便有效，并发症少，止血效果即刻可见。经典的B—Lynch缝合法虽也用于前置胎盘引起的产后出血，但效果似乎不如在单纯宫缩乏力中的好，尤其胎盘位置较低、合并胎盘粘连、胎盘剥离面出血活跃者更难显效。为此我们改良了B—Lynch术式，将切口下缘缝合点的位置下移，     

B-Lynch缝合法在剖宫产术中产后出血的应用

目的:探讨B-Lynch缝合法治疗剖宫产术中产后出血的疗效。方法:选择行剖宫产术中出现产后出血者80例为研究对象,其中40例应用B-Lynch缝合法止血(观察组),40例应用传统方法进行止血(对照组),将2组有效率、术中出血情况、手术时间和住院费用等进行对比。结果:与对照组相比,观察组术中、术后出血量少,住院时间短,住院费用低,差异均有统计学意义(P<0.01),且术后恢复良好,无并发症发生。结论:B-Lynch缝合法是治疗剖宫产术中产后出血的有效方法,值得推广。     

B-Lynch缝合术规范化培训在临床应用中的指导价值

目的：通过比较规范化培训前后的临床相关指标,分析B-Lynch缝合术规范化培训在临床应用中的指导价值。方法：收集2008年4月至2013年3月在同济大学附属第一妇婴保健院、浦东妇幼保健院及嘉定妇幼保健院实施B-Lynch缝合术的182例单胎、产后出血病例,比较B-Lynch规范化培训前后培训组（145例）和对照组（37例）BLynch缝合前出血量、缝合术后2h出血量、输血率、联合实施子宫动脉上行支结扎术、子宫切除率、宫缩剂使用等指标的差异。结果：与对照组比较,培训组B-Lynch缝合术后2h出血量减少（P〈0.05）,输血率降低（P〈0.05）,规范化培训后术者操作时间明显缩短（P〈0.001）,联合应用子宫动脉上行支结扎术的比率显著降低（P=0.03）,宫缩剂卡前列素氨丁三醇（欣母沛）用量显著降低（P=0.044）,而卡贝缩宫素（巧特欣）用量无显著差异（P〉0.05）。两组的子宫切除率无显著差异（2.1%vs 2.7%,P〉0.05）。结论：规范化培训有利于缩短B-Lynch缝合时间,降低缝合术后2h出血量和输血量,并且减少了昂贵缩宫剂的使用,从卫生经济学角度有助于节约医疗费用和资源。     

Bakri球囊填塞与B-Lynch缝合在剖宫产产后出血中的效果观察

目的 探讨Bakri球囊填塞法与B-Lynch缝合法在剖宫产产后出血中的疗效。方法 选取62例剖宫产产后出血产妇,采用随机数字表法分为A组与B组,各31例。A组产妇采用Bakri球囊填塞法治疗,B组产妇采用B-Lynch缝合法治疗。对比两组产妇术中出血量、术后2 h出血量、术后24 h出血量、手术时间、住院时间及并发症发生情况。结果 A组产妇术中、术后2 h出血量及24 h出血量均明显少于B组,差异均具有统计学意义（P<0.05）。A组产妇手术时间及住院时间均短于B组,差异具有统计学意义（P<0.05）。A组产妇术后并发症发生率3.23%明显低于B组的25.81%,差异具有统计学意义（P<0.05）。结论 相比B-Lynch缝合法,Bakri球囊填塞法治疗剖宫产产后出血临床疗效更为突出,其不仅能明显减少产妇术中及术后出血量,且临床并发症少,术后康复快。     

B-Lynch suture, intrauterine balloon, and endouterine hemostatic suture for the management of postpartum hemorrhage due to placenta previa accreta

Objective

To report our experience with a new conservative management approach to treat postpartum hemorrhage (PPH) due to placenta previa accreta.

Methods

A retrospective study of 9 patients with placenta previa accreta who underwent a conservative management protocol. The protocol consists of preventive radiological catheterization of the descending aorta, cesarean delivery, use of Affronti endouterine square hemostatic sutures, and placement of an intrauterine Bakri balloon in conjunction with B-Lynch suture. In the event of failure of the protocol, subsequent management employs ligation and/or reversible embolization of the uterine arteries followed by hysterectomy if unsuccessful.

Results

Conservative management of PPH was successful in all 9 patients evaluated and avoided the need for ligation and/or reversible embolization of the uterine arteries.

Conclusion

Management of PPH is dictated by several considerations including hemodynamic status and desire to preserve fertility. The initial results of this conservative protocol for treatment of PPH in high-risk patients with placenta previa accreta are encouraging.     

Ten year follow-up of the effect of the B-Lynch uterine compression suture for massive postpartum hemorrhage

The B-Lynch surgical technique for the management of massive postpartum hemorrhage (PPH) has been used successfully since 1989 in cases where bleeding was secondary to uterine atony with failed conservative management. It allows for conservation of the uterus for subsequent menstrual function and pregnancies. In this report, we present a follow up of a case with successful pregnancy ten years after PPH was managed with the B-Lynch uterine compression suture to demonstrate the long-term anatomical consequences of this operation. This case represents the longest follow up after the application of the B-Lynch suture (brace suture) technique for the control of massive PPH as an alternative to hysterectomy. Published data have confirmed that on the balance of probability, the B-Lynch surgical technique is safe, effective and free of short- and long-term complication.     

Technical description of the B-Lynch brace suture for treatment of massive postpartum hemorrhage and review of published cases

Massive uncontrolled hemorrhage after childbirth is a leading cause of the pregnancy-related death and resulting morbidity. Uterine atony is the most common cause (75-90%) of primary postpartum hemorrhage. When simple massage of the uterus and uterotonics such as oxytocins, syntometrine and prostaglandins failed to manage this condition, various surgical solutions have been sought, including uterine artery ligation, more complicated stepwise devascularization of the uterus, internal iliac artery ligation and, ultimately, hysterectomy. All these procedures require above average surgical skill. In contrast, the B-Lynch suturing technique (brace suture) is particularly useful because of its simplicity of application, life saving potential, relative safety and capacity for preserving the uterus and subsequent fertility. The adequacy of haemostasis can be assessed both before and immediately after application of the suture. Only if it fails need other more radical surgical methods be considered. The special advantage of this innovative technique is that it presents an alternative to major surgical procedures for controlling pelvic arterial pulse pressure or hysterectomy. To date, this suturing technique, when applied correctly, has been successful with no problems and no apparent complications. This review provides an update on the B-Lynch brace suturing technique, including choice of suture material, use of the technique in early and late gestation, and comparison with other uterine compression surgical techniques. It also includes a comprehensive review and analysis of all published cases and their postoperative follow-up.     

Successful of the B-Lynch compression suture in the management of massive postpartum hemorrhage: case reports and review

The authors describe three patients who developed massive primary postpartum hemorrhage and review the case reports. In two patients, primary postpartum hemorrhage was due to uterine atony, and in one patient it was due to atony and thrombophilia. In all three patients, excellent effect was achieved with hemorrhage reduction by a compression B-Lynch suture alone, with bimanual compression following medicamentous uterotonic therapy. B-Lynch suture is an efficient, safe, and simple method for the treatment of primary postpartum hemorrhage during cesarean section, which successfully reduces the number of urgent postpartum hysterectomies, also preserving subsequent fertility. In our opinion, the method should be included in the algorithm of primary postpartum hemorrhage management at all obstetric departments.     

Successful term pregnancy after B-Lynch compression suture in a previous pregnancy on account of massive primary postpartum hemorrhage

A case is presented of a successful term pregnancy in a 28-year-old secundipara after previous Misgav-Ladach cesarean section and B-Lynch compression suture on account of massive postpartal hemorrhage caused by uterine atony. On account of dystocia and relative cephalopelvic disproportion, secondary repeated cesarean section was performed; she gave birth to a live child 3,900 g/52 cm, Apgar score 9/10, with a regular neonatal course. During the repeated cesarean section, thin laces of connective tissue were found along the sutures placed on the uterus during the previous B-Lynch operation. Pelvic and intrauterine adhesions were not found.