CAJ | 학술논문

目的：探讨治疗难治性产后出血实施改良B－Lynch缝合术的时机选择，并通过评价其安全性，为临床上推广此项技术特别是在基层医院运用此项技术有效治疗难治性产后出血提供依据。方法：本研究选择2012年3月至2015年7月于本院行剖宫产手术，术中发生产后出血达800ml以上，出血原因包括子宫收缩乏力性、前置胎盘等原因，经按摩子宫、药物加强宫缩、局部缝扎止血等处理无效行改良B－Lynch缝合术的产妇。分为A组：产后出血量达800 ml行改良B－Lynch缝合术者；B组：产后出血量达1200 ml行改良B－Lynch缝合术者；C组：产后出血达1200 ml未行改良B－Lynch缝合术者。评估患者出血量、子宫切除率、子宫复旧及其功能恢复情况、术后并发症发生率等，评价改良B－Lynch缝合术手术时机的选择及其安全性。结果：三组患者出血量有显著性差异（P＜0．01）；A组患者无一例需行子宫切除，未发生其它并发症。结论：在剖宫产术中发生产后出血，及时行B－Lynch缝合术可以明显减少产后出血量，产后出血量达800 ml行改良B－Lynch缝合术者，对难治性宫缩乏力性产后出血效果显著，值得推广。
목적：탐토치료난치성산후출혈실시개량B－Lynch봉합술적시궤선택，병통과평개기안전성，위림상상추엄차항기술특별시재기층의원운용차항기술유효치료난치성산후출혈제공의거。방법：본연구선택2012년3월지2015년7월우본원행부궁산수술，술중발생산후출혈체800ml이상，출혈원인포괄자궁수축핍력성、전치태반등원인，경안마자궁、약물가강궁축、국부봉찰지혈등처리무효행개량B－Lynch봉합술적산부。분위A조：산후출혈량체800 ml행개량B－Lynch봉합술자；B조：산후출혈량체1200 ml행개량B－Lynch봉합술자；C조：산후출혈체1200 ml미행개량B－Lynch봉합술자。평고환자출혈량、자궁절제솔、자궁복구급기공능회복정황、술후병발증발생솔등，평개개량B－Lynch봉합술수술시궤적선택급기안전성。결과：삼조환자출혈량유현저성차이（P＜0．01）；A조환자무일례수행자궁절제，미발생기타병발증。결론：재부궁산술중발생산후출혈，급시행B－Lynch봉합술가이명현감소산후출혈량，산후출혈량체800 ml행개량B－Lynch봉합술자，대난치성궁축핍력성산후출혈효과현저，치득추엄。
Objective: To probe the timing of the intractabe postpartum hemorrhage treated by Modified B-Lynch suture technique, and assess its safety to provide the basis for the promotion of this technology, especially the use in the primary hospital. Methods: The Puerperas in this study were selected from the cesarean section in our hospital, March 2012 to July 2015. The cases requirements was postpartum hemorrhage of more than 800 ml,the causes of bleeding include uterine inertia,placenta previa and through the massg of the uterus,drug strengthen contractions, partial suture and the other treatment ineffective. The cases were divided into 3 groups. Group A: postpartum hemorrhage volume of 800ml with modified B-Lynch suture surgeon , Group B: postpartum hemorrhage volume of 1200 ml with modified B-Lynch suture surgeon , Group C: postpartum hemorrhage did not line up to 1200 ml modified B-Lynch suture surgeon. The patients of bleeding, hysterectomy rate, uterine involution and functional recovery rate of postoperative complications were assessed. And the timing and security of the modified B-Lynch suture technique surgical were evaluated among groups. Results: Three groups of patients with bleeding volume was significant difference (P<0.01);None of patients in group A needed hysterectomy and occurred other complications. Conclusion:Postpartum hemorrhage in cesarean section , the time line B-Lynch suture technique can significantly reduce the amount of postpartum hemorrhage. Postpartum hemorrhage volume of 800ml with modified B-Lynch suture surgeon is significant to refractory postpartum hemorrhage, worthy of promotion.