中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2013年
3期
165-170
,共6页
李巨%于月新%郑莉彦%杨丽娜%孙春燕%陈震宇
李巨%于月新%鄭莉彥%楊麗娜%孫春燕%陳震宇
리거%우월신%정리언%양려나%손춘연%진진우
剖宫产术%子宫出血%宫缩乏力%止血,手术%动脉%结扎术
剖宮產術%子宮齣血%宮縮乏力%止血,手術%動脈%結扎術
부궁산술%자궁출혈%궁축핍력%지혈,수술%동맥%결찰술
Cesarean section%Uterine hemorrhage%Uterine inertia%Hemostasis,surgical%Arteries%Ligation
目的 探讨子宫体双侧弓形动脉缝扎术(简称:止血术)在处理剖宫产术中子宫收缩乏力性出血的止血效果及其对产后子宫血管及血循环的影响.方法 选择2009年5月至2011年12月,在解放军第二○二医院行剖宫产术中因子宫收缩乏力性出血,经保守治疗无效的127例患者,采用无创1号可吸收缝线距子宫下段剖宫产切口上缘及宫体外侧缘2 cm交汇处,贯穿子宫前、后壁环绕宫体并于宫底略前方拉紧、打结,为止血术组.另选同期23例经保守治疗和其他止血方式无效改行止血术者为其他+止血术组；62例患者在剖宫产术中确认子宫体收缩乏力性出血,在给予促宫缩药物的同时立即行止血术为药物+止血术组.止血术时,计算各组出血量、手术时间、即刻止血率及止血总有效率.产后6～12个月行阴道彩超检查双侧子宫动脉阻抗指数(RI)及收缩期峰值与舒张末期血流速度(S/D)比值；并以64排增强CT检查患者双侧子宫动脉显影情况及测量子宫动脉直径.结果 (1)药物+止血术组患者出血量、手术时间及即刻止血率分别为(532 ±28) ml、(34±3) min及97％ (60/62),止血术组出血量为(1150 ±43) ml,手术时间为(61±4)min,即刻止血率为95％(120/127),但两组比较,差异无统计学意义(P＞0.05)；其他+止血术组经保守治疗和其他手术方式止血均无效后采用止血术,出血量、手术时间、即刻止血率分别为(1379 ±95) ml、(79±15) min及78％(18/23),与止血术组和药物+止血术组分别比较,差异均有统计学意义(P＜0.01),但3组患者止血总有效率分别比较,差异无统计学意义(P＞0.05).(2)产后6 ～12个月阴道彩超测量3组患者双侧子宫动脉RI及S/D比值,3组患者左、右侧子宫动脉的RI及S/D比值分别比较,差异均无统计学意义(P＞0.05).(3)3组各有部分患者在术后6 ～12个月行盆腔64排增强CT检查,其他+止血术组患者左侧子宫动脉显影率(13/15)明显低于止血术组(97％,28/29)和药物+止血术组(95％,20/21),两者比较,差异有统计学意义(P＜0.05)；后两组患者左、右侧子宫动脉显影率及子宫动脉直径分别比较,差异均无统计学意义(P＞0.05).结论 止血术用于剖宫产术中子宫收缩乏力性出血,具有操作简单迅速、止血效果确切等优点,对患者术后子宫及卵巢的血管及血循环也无明显影响,是一种值得推广的新术式.
目的 探討子宮體雙側弓形動脈縫扎術(簡稱:止血術)在處理剖宮產術中子宮收縮乏力性齣血的止血效果及其對產後子宮血管及血循環的影響.方法 選擇2009年5月至2011年12月,在解放軍第二○二醫院行剖宮產術中因子宮收縮乏力性齣血,經保守治療無效的127例患者,採用無創1號可吸收縫線距子宮下段剖宮產切口上緣及宮體外側緣2 cm交彙處,貫穿子宮前、後壁環繞宮體併于宮底略前方拉緊、打結,為止血術組.另選同期23例經保守治療和其他止血方式無效改行止血術者為其他+止血術組；62例患者在剖宮產術中確認子宮體收縮乏力性齣血,在給予促宮縮藥物的同時立即行止血術為藥物+止血術組.止血術時,計算各組齣血量、手術時間、即刻止血率及止血總有效率.產後6～12箇月行陰道綵超檢查雙側子宮動脈阻抗指數(RI)及收縮期峰值與舒張末期血流速度(S/D)比值；併以64排增彊CT檢查患者雙側子宮動脈顯影情況及測量子宮動脈直徑.結果 (1)藥物+止血術組患者齣血量、手術時間及即刻止血率分彆為(532 ±28) ml、(34±3) min及97％ (60/62),止血術組齣血量為(1150 ±43) ml,手術時間為(61±4)min,即刻止血率為95％(120/127),但兩組比較,差異無統計學意義(P＞0.05)；其他+止血術組經保守治療和其他手術方式止血均無效後採用止血術,齣血量、手術時間、即刻止血率分彆為(1379 ±95) ml、(79±15) min及78％(18/23),與止血術組和藥物+止血術組分彆比較,差異均有統計學意義(P＜0.01),但3組患者止血總有效率分彆比較,差異無統計學意義(P＞0.05).(2)產後6 ～12箇月陰道綵超測量3組患者雙側子宮動脈RI及S/D比值,3組患者左、右側子宮動脈的RI及S/D比值分彆比較,差異均無統計學意義(P＞0.05).(3)3組各有部分患者在術後6 ～12箇月行盆腔64排增彊CT檢查,其他+止血術組患者左側子宮動脈顯影率(13/15)明顯低于止血術組(97％,28/29)和藥物+止血術組(95％,20/21),兩者比較,差異有統計學意義(P＜0.05)；後兩組患者左、右側子宮動脈顯影率及子宮動脈直徑分彆比較,差異均無統計學意義(P＞0.05).結論 止血術用于剖宮產術中子宮收縮乏力性齣血,具有操作簡單迅速、止血效果確切等優點,對患者術後子宮及卵巢的血管及血循環也無明顯影響,是一種值得推廣的新術式.
목적 탐토자궁체쌍측궁형동맥봉찰술(간칭:지혈술)재처리부궁산술중자궁수축핍력성출혈적지혈효과급기대산후자궁혈관급혈순배적영향.방법 선택2009년5월지2011년12월,재해방군제이○이의원행부궁산술중인자궁수축핍력성출혈,경보수치료무효적127례환자,채용무창1호가흡수봉선거자궁하단부궁산절구상연급궁체외측연2 cm교회처,관천자궁전、후벽배요궁체병우궁저략전방랍긴、타결,위지혈술조.령선동기23례경보수치료화기타지혈방식무효개행지혈술자위기타+지혈술조；62례환자재부궁산술중학인자궁체수축핍력성출혈,재급여촉궁축약물적동시립즉행지혈술위약물+지혈술조.지혈술시,계산각조출혈량、수술시간、즉각지혈솔급지혈총유효솔.산후6～12개월행음도채초검사쌍측자궁동맥조항지수(RI)급수축기봉치여서장말기혈류속도(S/D)비치；병이64배증강CT검사환자쌍측자궁동맥현영정황급측양자궁동맥직경.결과 (1)약물+지혈술조환자출혈량、수술시간급즉각지혈솔분별위(532 ±28) ml、(34±3) min급97％ (60/62),지혈술조출혈량위(1150 ±43) ml,수술시간위(61±4)min,즉각지혈솔위95％(120/127),단량조비교,차이무통계학의의(P＞0.05)；기타+지혈술조경보수치료화기타수술방식지혈균무효후채용지혈술,출혈량、수술시간、즉각지혈솔분별위(1379 ±95) ml、(79±15) min급78％(18/23),여지혈술조화약물+지혈술조분별비교,차이균유통계학의의(P＜0.01),단3조환자지혈총유효솔분별비교,차이무통계학의의(P＞0.05).(2)산후6 ～12개월음도채초측량3조환자쌍측자궁동맥RI급S/D비치,3조환자좌、우측자궁동맥적RI급S/D비치분별비교,차이균무통계학의의(P＞0.05).(3)3조각유부분환자재술후6 ～12개월행분강64배증강CT검사,기타+지혈술조환자좌측자궁동맥현영솔(13/15)명현저우지혈술조(97％,28/29)화약물+지혈술조(95％,20/21),량자비교,차이유통계학의의(P＜0.05)；후량조환자좌、우측자궁동맥현영솔급자궁동맥직경분별비교,차이균무통계학의의(P＞0.05).결론 지혈술용우부궁산술중자궁수축핍력성출혈,구유조작간단신속、지혈효과학절등우점,대환자술후자궁급란소적혈관급혈순배야무명현영향,시일충치득추엄적신술식.
Objectives To investigate the effect of bilateral arcuate artery suture hemostasis of corpus uteri (haemostasia) for postpartum hemorrhage due to uterine inertia during caesarean section,and to explore the change of blood vessels and blood flow of the uterus after surgery.Methods From May 2009 to Dec.2011,the 212 patients in No.202 People's Liberation Army Hospital received bilateral arcuate artery suture hemostasis of corpus uteri for postpartum hemorrhage due to uterine inertia during caesarean section.Among them,127 patients who failed to respond to conservative management and received haemostasia were defined as the ‘ haemostasia' group.23 patients who received the suture after they failed to respond to conservative management and other conventional surgical hemostasis were defined as the ‘ other +haemostasia' group.62 patients who received the suture simultaneously with conservative management were defined as the ‘ drug + haemostasia' group.The suture was done by the following steps:(1) The uterus should be exteriorised,and the fundus of uterus should be towards the head.(2)Transfix the anterior and posterior wall of corpus uteri with big blunt round needle and absorbable suture.The entry point was 2 cm above the uterine incision and 2 cm to lateral border of corpus uteri.The suture spanned the fundus of uterus,and was stretched tightly in front of the fundus,then tied knots were made.Bleeding volume,prompt hemostatic rate,effect rate,total effect rate and operation time were recorded.The resistance index (RI) of uterine artery,systolic/ diastolic blood pressure (S/D),the visualization ratio of uterine artery and the mean value of artery diameter were obtained through color Doppler ultrasonography and enhancement CT 6-12 months after the surgery.Results (1) In the ‘ drug + haemostasia' group,the bleeding volume was (532 ±28) ml.The operation time was (34 ± 3) min,and the prompt hemostatic rate was 97％.While the ‘ haemostasia' group had more bleeding volume,longer operation time and lower prompt hemostatic rate than the ‘ drug + haemostasia' group,with no statistically significant difference (P ＞ 0.05).In ‘ other + haemostasia' group,the bleeding volume was (1379 ± 95) ml.The operation time was (79 ± 15) min,and the prompt hemostatic rate was 78％.The differences were significant when compared to the other groups (P ＜ 0.01).There was no statistically significant difference on total effect rate among the three groups (P ＞ 0.05).(2) There was no statistically significant difference on the RI and S/D of bilateral uterine artery among all the groups 6-12 months after the surgery.(3)The visualization ratio of left uterine artery of the ‘ other + haemostasia' group was lower (87％) than the ‘ haemostasia' group (97％) and the ‘ drug +haemostasia' group (95％,P ＜ 0.05).There was no statistically significant difference between the ‘ haemostasia' group and the ‘ drug + haemostasia' group on the visualization ratio of bilateral uterine artery and the mean value of bilateral uterine artery diameter (P ＞ 0.05).Conclusions The bilateral arcuate artery suture hemostasis of corpus uteri is a simple,rapid,effective and safe method to control postpartum hemorrhage due to uterine inertia during caesarean section.The ovary and uterine blood flow are not affected after the surgery.
