改良式B-Lynch缝合术在剖宫产术中出血的应用

目的探讨改良式B-Lynch缝合术治疗剖宫产术中出血的临床效果。方法选取35例剖宫产术中出血的患者,采用二种手术止血方式,分别为改良式B-Lynch缝合术(B-Lynch组,20例)和宫腔内水囊纱布垫压迫止血法(对照组,15例)进行对比,记录平均手术时间、术中出血量及24 h总出血量、宫腔粘连、子宫缺血坏死、产褥病率。结果 B-Lynch组平均手术时间(56.4±7.6)min,术中及24 h总出血量(302.3±25.5)m L、(398.2±23.4)m L;对照组平均手术时间(86.4±9.3)m L及术中、24 h总出血量分别为(507.9±29.6)m L、(503.8±33.2)m L,差异有统计学意义(P0.05)。对照组的宫腔黏连(13.3%)、产褥病率(20.0%)显著高于B-Lynch组的0.0%、5.0%(P0.05),两组比较子宫缺血坏死差异无统计学意义(P0.05)。改良式B-Lynch缝合术比宫腔内水囊纱布垫压迫止血法手术时间短,术中出血及术后至24 h出血量、宫腔黏连、产褥病率少。结论对剖宫产术中出血采用改良式B-Lynch缝合术操作方法简单,手术时间短,能够有效止血,并发症发生率较低,术后无需再次手术,临床效果好。

Application of modified B-Lynch suture in the remedy of hemorrhage during caesarean section

Objective To investigate the clinical effect of modified B-Lynch suture for hemorrhage during caesarean section. Methods 35 patients with hemorrhage in cesarean section received two methods of hemostasis. 20 patients were treated with modified B-Lynch suture, and the others were treated with Intra-uterine water sac hemostasis gauze pad. The average time of the operation,the amount of bleeding in operation and in 24 hours,intrauterine adhesions,uterine ischemia necrosis,and puerperal morbidity were recorded. Results In the B-Lynch group,the mean time of operation was 56. 4 ± 7. 6 min,the amount of bleeding in operation was 302. 3 ± 25. 5 mL and 398. 2 ± 23. 4 ml in 24 hours,respectively. In the control group,the mean time of operation wa 86. 4 ± 9. 3 mL; the amount of bleeding in operation was507. 9 ± 29. 6 mL and 503. 8 ± 33. 2 mL in 24 hours. There were significant differences between two groups（ P〈0. 05）. The rates of intrauterine adhesions（ 13. 3%） and puerperal morbidity（ 20. 0%） in control group were obviously higher than the B-Lynch group（ 0. 0% 、5. 0%）（ P〈0. 05）. The rate of uterine ischemia necrosis had no significant difference（ P〉0. 05）. Conclusion Modified B-Lynch suture for hemorrhage during caesarean section has advantages of easier manipulation, less operation time and lower rate of complication,without the need of secondary operation.