改良B-Lynch缝合术联合治疗在难治性产后出血中的应用

目的 探讨改良B-Lynch缝合术联合宫内球囊压迫术及阴道塞纱在难治性产后出血治疗中的应用价值.方法选择2014年1月至2016年1月期间在浙江省瑞安市妇幼保健院妇产科住院分娩的60例难治性产后出血产妇,随机分为观察组和对照组.观察组予以改良B-Lynch缝合术联合宫内球囊压迫术及阴道塞纱治疗,对照组予以宫内球囊压迫术及阴道塞纱治疗.比较两组产妇的止血成功率及子宫切除情况,观察两组产妇的术中出血量、术后24 h出血量、止血时间、输血量、产褥病率及住院时间.探讨两种手术方式的疗效及安全性差异.结果观察组术中出血量、止血时间、术后24h出血量、输血量均显著少于对照组(t值分别为2.14、2.31、2.43、2.37,均P<0.05),观察组产褥病发生率显著低于对照组(χ2=4.32,P<0.05),两组住院时间比较无统计学差异(t=1.42,P>0.05).观察组止血成功率显著高于对照组(χ2=4.63,P<0.05),观察组子宫切除率显著低于对照组(χ2=4.63,P<0.05).结论改良B-Lynch缝合术联合宫内球囊压迫术及阴道塞纱治疗难治性产后出血能快速有效的止血,减少产妇术中及术后的出血量,减少切除子宫的发生,有利于产妇的恢复.

Application of improved B-Lynch suture combination treatment on treatment of intractable postpartum hemorrhage

Objective To discuss the application value of improved B-Lynch suture combined with intrauterine balloon compression and vaginal yarn on treatment of intractable postpartum hemorrhage .Methods A total of 60 cases of pregnant women with intractable postpartum hemorrhage were selected and divided into observation group and control group at random .The pregnant women in the observation group were given improved B-Lynch suture combined with intrauterine balloon compression and vaginal yarn , while the pregnant women in the control group were only given intrauterine balloon compression and vaginal yarn .Hemostasis successful rates and hysterectomy of pregnant women in two groups were compared .Meanwhile, intraoperative bleeding volume , bleeding volume 24 hours after operation , hemostatic time, blood transfusion volume , puerperal morbidity and length of hospital stay of pregnant women in two groups were observed , and the curative effect and security difference of the above two operative methods were discussed as well .Results The intraoperative bleeding volume, hemostatic time, bleeding volume 24 hours after operation and blood transfusion volume of pregnant women in the observation group were less or shorter than those in the control group (t value was 2.14, 2.31, 2.43 and 2.37, respectively, all P<0.05).The puerperal morbidity of pregnant women in the observation group was lower than that in the control group (χ2 =4.32, P <0.05). Comparison of the length of hospital stay between two groups showed no statistical difference ( t =1.42, P >0.05).The hemostasis successful rate of pregnant women in the observation group was higher than that in the control group (χ2 =4.63, P<0.05), and the hysterectomy rate was lower than in the control group (χ2 =4.63,P<0.05).Conclusion The application of improved B-Lynch suture combined with intrauterine balloon compression and vaginal yarn on treatment of intractable postpartum hemorrhage has prompt and effective hemostasis effect and reduces bleeding volume during and after operation .The application can avoid the occurrence of hysterectomy and is good for recovery of pregnant women .It is a safe and effective method .