平行垂直压迫缝合技术治疗剖宫产术中前置胎盘大出血的效果评价  

Effect evaluation of parallel vertical compression suture in the treatment of bleeding due to placenta previa during cesarean section

作　　者：宋改环[1] 奚杰[2] 白延青[1] 周宁[1] 

机构地区：[1]宁波大学医学院附属医院,宁波315020 [2]上海市嘉定区妇幼保健院

出　　处：《现代实用医学》2012年第7期730-732,共3页Modern Practical Medicine

基　　金：宁波市社会发展基金资助项目(2009C50012)

摘　　要：目的评价子宫下段平行垂直压迫缝合术治疗剖宫产术中前置胎盘大出血的临床疗效。方法回顾性分析应用子宫下段平行垂直压迫缝合术治疗的59例剖宫产术中前置胎盘剥离面出血的患者的临床资料。结果 59例患者均保留了子宫,1例胎盘植入患者伴随宫缩乏力,同时行B-Lynch缝合术,胎盘局部"8"字缝合术及缝扎双侧子宫动脉上行支后出血渐止,1例伴宫缩乏力同时行B-Lynch缝合术,4例因宫缩乏力及胎盘剥离面出血配合行B-Lynch缝合术+胎盘局部8字缝合术,15例同时行胎盘剥离面局部"8"字缝合术,无一例因血液动力学改变及再出血行再次手术。术后无并发症发生,子宫复旧正常,随访30例月经复潮时间无异常。结论平行垂直压迫缝合术是一种简单有效的压迫前置胎盘剥离面止血方式,但胎盘剥离面出血面积大,单纯应用子宫下段平行垂直压迫缝合术不能有效止血时,配合应用其他缝合术是必要的。Objective To evaluate he clinical efficacy of parallel vertical compression suture in the treatment of bleeding within the lower uterine segment due to placenta previa during cesarean section. Methods Parallel vertical compression suture was applied among 59 patients with bleeding due to placenta previa during cesarean section. Re- sults The parallel vertical compression suture was successful in avoiding hysterectomy among 59 patients. One pa- tient with placenta accreta was managed with B-Lynch suture, 8-shape suture and bilateral ascending uterine arteries ligation; B-Lynch suture was done in 1 case with uterine inertia; B-Lynch suture and 8-shape suture were done in 4 cases and 8-shape suture were perfomed in 15 cases besides parallel vertical compression suture. Hemadynamics was stable and bleeding did not happen after operation. None of 59 cases were operated again. No postoperative complic- ations occurred, and there was no abnormality of uterine involution and the menstrual time among the 30 patients who received follow-up. Conclusions Parallel vertical compression suture is an easy, effective surgical hemostasis way in the treatment of bleeding within the lower uterine segment due to placenta previa during cesarean section, but it is necess- ary to apply other sutures at the same time when bleeding is severe.

关 键 词：剖宫产术 胎盘 前置 产后出血 平行垂直压迫缝合术 

分 类 号：R719.8[医药卫生—妇产科学]