子宫压迫缝合术：过去、现在和将来

子宫压迫缝合术是20世纪末期兴起的产后出血保守性手术方法,虽然取得很好的效果,但仍不断有改良的子宫压迫缝合术或子宫压迫缝合术结合其他方法治疗产后出血的报道。通过介绍子宫压迫缝合术适应证的扩展、以及目前尚未解决的问题,阐述子宫压迫缝合术的研究方向。     

子宫压迫缝合术:过去、现在和将来

子宫压迫缝合术是20世纪末期兴起的产后出血保守性手术方法,虽然取得很好的效果,但仍不断有改良的子宫压迫缝合术或子宫压迫缝合术结合其他方法治疗产后出血的报道.通过介绍子宫压迫缝合术适应证的扩展、以及目前尚未解决的问题,阐述子宫压迫缝合术的研究方向.     

B-Lynch及其他保守缝合法在产后出血中的应用

子宫压迫缝合术是用于治疗产后出血的一系列新方法,包括B-Lyneh缝合术、Cho缝合术、子宫下段平行垂直压迫缝合术.子宫压迫缝合术操作简单、迅速、安全、易于推广.     

子宫压迫缝合术在产后出血治疗中的临床应用研究

目的:探讨子宫压迫缝合术在产后出血(除外软产道损伤所致出血)治疗中的止血效果。方法:回顾性分析及评价2007年8月至2011年6月我院收治的112例产后出血患者,采用不同方式的子宫压迫缝合术治疗不同原因的产后出血的效果。结果:112例患者中111例经子宫压迫缝合术治疗后能有效止血,有效率99.1%。术后均无并发症发生,42天B超检查除1例提示子宫切口见3mm×4mm液性暗区,其余均提示子宫切口愈合良好,子宫体血运良好,无晚期产后出血的发生。结论:子宫压迫缝合术可用于治疗各种原因所致的产后出血,术式简单易学,疗效较好。     

剖宫产产后出血治疗中子宫压迫缝合术的临床效果研究

目的 分析剖宫产产后出血产妇使用子宫压迫缝合术治疗的临床效果。方法 选取100例剖宫产产后出血产妇,根据随机抽样法将产妇分为对照组与研究组,每组50例。对照组使用常规止血,研究组使用子宫压迫缝合术止血。比较两组产妇的治疗效果、并发症发生情况及临床指标。结果 研究组治疗总有效率96.00%高于对照组的80.00%,差异有统计学意义（P<0.05）。研究组术中出血量少于对照组,止血时间、恶露干净时间、子宫恢复正常时间、月经恢复时间及住院时间均短于对照组,差异有统计学意义（P<0.05）。研究组并发症发生率明显低于对照组,差异有统计学意义（P<0.05）。结论 剖宫产产后出血产妇应用子宫压迫缝合术进行治疗,可以减少产妇术中出血量,缩短止血时间,促进产妇子宫、月经恢复正常,值得临床推广。     

子宫背带式缝合术在剖宫产产后出血中的临床应用

目的:探讨子宫背带式缝合术在剖宫产产后出血中的临床应用价值。方法:本文对我院2008年1月至2011年08月采取子宫背带式缝合术治疗剖宫产产后出血的11例患者治疗情况进行回顾分析。结果:在本组资料中经子宫背带式缝合术治疗的宫缩乏力性产后出血患者效果显著,随访3～12个月没有发生远期并发症。结论:子宫背带式缝合术是对产后出血行之有效的外科手术止血方法,其优点有:保留子宫且无并发症发生、止血迅速可靠、操作简单易行等,由此值得在临床应用中大力推广。     

高危妊娠剖宫产术中应用改良式子宫Hayman缝合术与子宫B-lynch缝合术预防产后出血的临床对照研究

目的 探讨高危妊娠剖宫产术中应用改良式子宫Hayman缝合术与子宫B-lynch缝合术预防产后出血的临床效果。方法 选取2019年1月—2021年12月收治的产后宫缩乏力有产后出血倾向的患者35例为对照组,另选2022年1月—2023年8月收治的产后宫缩乏力有产后出血倾向的患者35例为观察组。两组均行子宫下段剖宫产,观察组术中应用改良式子宫Hayman缝合术,对照组术中应用子宫B-lynch缝合术,比较两组治疗有效率、临床指标、输血率、产后出血发生率。结果 两组治疗有效率比较差异无统计学意义（P>0.05）;两组血性恶露持续时间比较差异无统计学意义（P>0.05）;观察组手术时间、止血时间、住院时间均短于对照组,术中、术后2 h及术后24 h出血量均少于对照组（P<0.05）;观察组输血率、产后出血发生率均低于对照组（P<0.05）。结论 改良式子宫Hayman缝合术与子宫B-lynch缝合术在预防高危妊娠剖宫产产后出血中治疗效果相同,但改良式子宫Hayman缝合术可缩短手术与住院时间,减少术中及术后出血量,降低产后出血并发症发生率,还可降低输血率,值得临床推广...     

子宫压迫缝合致子宫肌层坏死3例报道

目的:探讨子宫压迫缝合的手术方法、手术时机与手术并发症的相关性。方法:回顾分析2014年12月到2017年6月河南濮阳市油田总医院产科收治的3例因子宫压迫缝合致子宫肌层坏死患者的临床资料。结果:3例患者伴有严重产后出血或子宫下段肌层薄弱,采用子宫压迫缝合后出现不同程度子宫肌层坏死,感染。2例行二次开腹探查,最终切除子宫;1例宫腔镜检查证实子宫内膜坏死。结论:子宫压迫缝合对于产后出血有较好的治疗效果,但可导致严重并发症发生。对于合并失血性休克、DIC和凶险性前置胎盘的患者,子宫压迫缝合应作为治疗产后出血的一种辅助方法,缝合时需考虑子宫肌层血供情况,不宜为了止血而过多过密缝合。     

子宫压迫缝合术治疗产后出血的临床应用进展

产后出血是产科常见而严重的并发症,是导致产妇死亡的首要原因.子宫收缩乏力及胎盘因素是产后出血的主要原因.当使用药物加强子宫收缩难以奏效时,针对出血原因,迅速采取有效的压迫缝合止血方法,可以避免子宫切除.现总结近年来出现的各种子宫压迫缝合方法及其应用进展.     

产后出血手术治疗的评价

产后出血尤其是难治性产后出血,常导致大量输血以及输血并发症、子宫切除和重要脏器受损等后果,对孕产妇危害较大[1～5]。产后出血的治疗方案[1～4]可以分为:药物治疗(宫缩剂)和手术治疗(保守性手术治疗和子宫切除)。保守性手术治疗方式可以分为子宫压迫法和血管阻断法。现就剖宫产时产后出血的手术治疗进行阐述。1子宫压迫法根据压迫作用力产生的方向,分为子宫内压迫和子宫外压迫。子宫内压迫法为宫腔纱条填塞和宫腔球囊压迫;而子宫外压迫主要是各种子宫压迫缝合术     

Uterine compression sutures for postpartum hemorrhage: efficacy, morbidity, and subsequent pregnancy

OBJECTIVE: To review the efficacy, morbidity, and subsequent pregnancy outcome after uterine compression sutures for severe postpartum hemorrhage. METHODS: A 7-year review (2000-2006) of all uterine compression sutures for postpartum hemorrhage at one tertiary obstetric hospital. RESULTS: During the 7 years, 28 uterine compression sutures were performed in 31,519 deliveries (1 per 1,126). All were done at the time of cesarean delivery: 22 in 4,870 cesarean deliveries in labor (1 in 221) and 6 in 3,819 elective cesarean deliveries (1 in 637). The indications for suture were atonic postpartum hemorrhage in 25 of 28 (89%), placenta previa in 2 of 28 (7%), and partial placenta accreta in 1 of 28 (4%). Hysterectomy was avoided in 23 of 28 women (82%). Blood transfusion was needed in 13 of 28 (46%), and intensive care in 5 of 28 (18%). Seven women had subsequent uncomplicated term pregnancies, all delivered by elective repeat caesarean delivery. CONCLUSION: Uterine compression sutures for severe postpartum hemorrhage may obviate the need for hysterectomy and appear not to jeopardize subsequent pregnancy.     

产后出血47例临床诊治分析

目的:探讨产后出血的发生原因,总结临床治疗方法,以为日后对产后出血治疗提供参考。方法:回顾性分为我院2009年1月至2010年9月收治的47例产后出血患者的临床诊治方法,分析患者出现产后出血的原因。结果:47例患者中,有31例患者为子宫收缩乏力,9例患者为胎盘因素,5例患者为软产道裂伤,2例患者为凝血功能障碍。临床治疗可采用子宫按摩、注射催产素、修补软产道、宫腔填塞、手术等多种方法。结论:产后出血是临床较为常见的一种产后并发症,需要医生对患者提高注意,早期诊断,并给予正确的治疗。     

Risque de synéchie utérine après capitonnage utérin pour hémorragie du post-partum

ObjectivesUterine compression sutures are highly successful conservative surgical techniques used to treat severe postpartum haemorrhage. These methods can induce subsequent uterine synechiae. To determine this risk of synechiae after conservative uterine compression sutures, which may induce further fertility problems.Patients and methodsWe retrospectively reviewed the medical and pathological records of the patients who underwent uterine compression sutures for severe postpartum haemorrhage between January 2003 and March 2013 in a French University Hospital. The Cho's, the B-Lynch's and the Hayman's techniques have been used. The results of the hysteroscopies were detailed.ResultsAmong the 25 patients included, the B-Lynch or the Hayman's techniques have been used in 13 cases (52%). The Cho's technique has been performed alone for 5 patients (20%) and both techniques have been practiced in 7 situations (28%). In 17 cases (68%), some vascular sutures have been associated and, for 7 patients (28%), a vascular embolisation had been performed before the uterine compressive sutures. Only 19 patients underwent a diagnostic hysteroscopy and among them 13 had a normal uterine cavity (68%), 3 of them had uterine synechiae (16%) and 3 had placental retention (16%). Synechiae and retention have all been successfully removed by operative hysteroscopy.Discussion and conclusionThe compressive techniques can induce uterine synechiae, which may impair subsequent fertility.     

A new uterine suture technique for postpartum hemorrhage

At present, postpartum hemorrhage is still an important cause of maternal mortality and morbidity. When medical therapy has no success, conservative surgical procedures are applied before making a hysterectomy. Three transverse sutures are applied to the entire uterine wall both to the right and the left side of the uterus. Our technique has been applied to 4 women with postpartum hemorrhage secondary to uterine atony. Bleeding was stopped immediately by compressive sutures. The four patients had normal menstruation cycles after delivery and had new pregnancies. No woman had postoperative complications. Uterus compressive suture is an effective alternative to hysterectomy to treat postpartum hemorrhage secondary to atony. This is a simple and quick procedure that preserves fertility.     

宫腔填塞在产后出血的应用

在我国和大多数发展中国家,产后出血仍是孕产妇死亡的首位原因。发生产后出血时应尽快查明原因,积极综合治疗。本文主要阐述控制产后出血的保守治疗措施——宫腔填塞。通常是用纱布或球囊,尤其是近年来应用的Bakri球囊,放入子宫腔内起到止血作用,以减少子宫切除率。     

宫腔球囊填塞导致子宫破裂一例并文献复习

目的了解产后出血时宫腔球囊填塞导致子宫破裂的临床特点。 方法回顾分析1例宫腔球囊填塞术导致子宫破裂的诊治经过，并以"产后出血"、"宫腔球囊"、"宫腔填塞"、"子宫破裂"、"Bakri球囊"、"宫缩乏力"、"子宫切除"等为关键词在Medline、万方数据库、维普、中国知网、生物医学文献数据库及Embase生物医学全文数据库2000至2020年收录的文献中进行检索，对本例及文献中宫腔球囊填塞导致子宫破裂患者的诊断及治疗方法进行分析。 结果文献检索连同本例共有9例宫腔球囊填塞导致子宫破裂，其中7例使用Bakri球囊，1例使用BT-Cath球囊，1例使用宫腔球囊。球囊放置指征为阴道分娩后宫缩乏力(3例)、前置胎盘剖宫产后(2例)和晚期产后出血(4例)；7例在宫腔压迫期间发生子宫破裂，2例发生在球囊放置时；5例原发性产后出血伴子宫破裂患者中，4例行子宫修补，1例行子宫切除；4例晚期产后出血伴子宫破裂均行子宫切除术。 结论行宫腔球囊填塞术应警惕发生子宫破裂；应在超声监视下放置球囊；球囊填塞后仍然存在血流动力学不稳定时需考虑子宫破裂。     

血钙浓度与欣母沛预防产后出血的相关性研究

目的：探讨钙离子与欣母沛在预防产后出血中的协同作用。方法：选择2003—2010年在天津市水阁医院分娩无凝血功能障碍、无胎盘因素、无软产道裂伤,分娩后给予缩宫素20 U肌内注射15～30 min仍有活动性出血,及时给予欣母沛预防产后出血患者59例。按分娩前1周内所测血钙结果分为2组：正常血钙组27例,低血钙组32例。比较2组患者术中出血量、应用欣母沛治疗后24 h累计出血量、产后出血发生率和欣母沛用量。结果：低血钙组产妇与正常血钙组产妇在术中、应用欣母沛治疗后24 h累计出血量、产后出血发生率、欣母沛总量方面比较,差异均有统计学意义（均P＜0.01）。结论：血清钙浓度与欣母沛在预防产后出血中具有协同作用。     

Nécrose pariétale utérine partielle après capitonnage hémostatique selon la technique de Cho au cours d’une hémorragie du post-partum

A 38-year-old woman, gravida 2, para 2, underwent caesarean section at 41 weeks’ gestation and suffered postpartum hemorrhage due to uterine atony. Four Cho sutures were used to control hemorrhage. A systematic postpartum hysteroscopy showed a heterogenous whitish area of the fundus and MRI advocated placental retention. However, hysteroscopically guided biopsies confirmed the diagnosis of partial uterine necrosis. We emphasize the need to undergo postoperative follow-up to confirm uterine wall integrity after placement of compression sutures in order to document the complications of this procedure, which remain under evaluated.     

Pregnancy with asymptomatic uterine complete rupture after uterine artery embolization for postpartum hemorrhage

Objective

Uterine artery embolization has become an effective treatment for postpartum hemorrhage. The safety of pregnancy after uterine artery embolization for postpartum hemorrhage has been established.