子宫动脉下行支结扎联合子宫下段压迫缩窄缝合术在凶险性前置胎盘所致产后出血中的应用

目的探讨子宫动脉下行支结扎联合子宫下段压迫缩窄缝合术在凶险性前置胎盘所致产后出血中的应用。方法220例凶险性前置胎盘患者随机分为观察组(n=110)与对照组(n=110)。胎儿与胎盘娩出后,观察组给予子宫动脉下行支结扎加子宫下段压迫缩窄缝合法进行止血,对照组给予B-Lynch缝合联合子宫下段纱布填塞进行止血,对比2组患者手术时间、术中出血量、术后24 h出血量,术前血红蛋白、术后修正血红蛋白、住院时间、缩宫素、卡前列素氨丁三醇用量、输血、子宫动脉栓塞以及子宫切除率。结果观察组手术时间显著短于对照组,术中出血量及术后24 h出血量显著少于对照组,术后修正血红蛋白显著高于对照组(P0.01),2组术前血红蛋白比较差异无统计学意义(P0.05);观察组住院时间显著短于对照组,卡前列素氨丁三醇使用剂量显著低于对照组(P0.01),2组缩宫素使用剂量无显著差异(P0.05);观察组输血率、子宫动脉栓塞率以及子宫切除率分别为40.4%、2.7%和1.8%,均显著低于对照组的59.1%、10.9%和10.0%(P0.05)。结论子宫动脉下行支结扎联合子宫下段压迫缩窄缝合术可有效提高手术成功率。

Application of ligation for descending branch of uterine artery combined with lower uterine compression and coarctation suture in treating patients with postpartum hemorrhage caused by dangerous placenta previa

Objective To explore the clinical effects of ligation for descending branch of uterine artery combined with lower uterine compression and coarctation suture in treatment of patients with postpartum hemorrhage caused by dangerous placenta previa.Methods A total of 220 patients with dangerous placenta previa were randomly divided into the observation group (n =110) and the control group (n =110).The observation group was treated with descending branch of uterine artery ligation combined with lower uterine compression and coarctation suture,and the control group was treated with B-Lynch suture combined with inferior segment gauze packing.The operation time,intraoperative bleeding volume,postoperative 24 h bleeding,preoperative hemoglobin,postoperative hospitalization time,correction of hemoglobin,oxytocin and carboprost ammonia butyl alcohol three dosage,blood transfusion,uterine artery embolization,uterine resection rate were compared between the two groups.Results The operation time of the observation group was significantly shorter than the control group,the amount of intra-operative bleeding and postoperative 24 h blood loss were significantly less than the control group,postoperative correction of hemoglobin was significantly higher than the control group (P ＜0.01),and hemoglobin had no significant difference between the two groups before operation (P ＞ 0.05).In the observation group,hospitalization time was significantlyshorter than the control group,carboprost in ammonia butyl alcohol three dose was significantly lower than the control group (P ＜ 0.0 1),but the oxytocin dose had no significant difference between two groups (P ＞ 0.05).In the observation group,blood transfusion rate,uterine artery embolization rate and hysterectomy rate were 40.4％,2.7％ and 1.8％,which were significantly lower than 59.1％,10.9％ and 10％ in the control group (P ＜ 0.05).Conclusion Ligation for descending branch of uterine artery combined with lower uterine compression and coarctation suture can effectively improve the successful rate of surgery.