比较B-Lynch缝合与宫腔填塞治疗产后出血的疗效及对卵巢功能的影响  

Comparison of Effects of B-Lynch Suture and Uterine Tamponade on Postpartum Hemorrhage and Ovarian Function

作　　者：刘炜[1] 石礼红[1] 乔侨[2] 

机构地区：[1]上海市同济医院妇产科医学生殖中心,上海200065 [2]上海市第八人民医院妇产科,上海200235

出　　处：《南昌大学学报（医学版）》2014年第10期29-32,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的比较B-Lynch缝合术与宫腔纱条填塞治疗剖宫产术中出血的效果以及对卵巢功能的影响。方法回顾性分析保守治疗无效的59例剖宫产产后出血患者,其中36例采用B-Lynch缝合术治疗(A组),23例采用宫腔纱条填塞治疗(B组)。比较2组患者手术时间、出血量、治疗有效率、术后贫血、术后发热或感染率;产后恢复情况:出院42d子宫复旧率,1年内月经恢复情况(月经量、月经周期),6个月内宫腔粘连发生率和术后第1次月经周期D1—D3E2、FSH、LH和LH/FSH水平。结果 A组和B组有效率分别为97.2%、90.5%,2组比较差异有统计学意义(P<0.05),且B组较A组手术时间明显延长[(154±31)min比(112±36)min,P<0.05],术中出血量增多[(705±152)mL比(564±112)mL,P<0.05],术后24h阴道出血量亦增多[(230±44)mL比(115±32)mL,P<0.05],术后贫血发生率减少(26.1%比33.3%,P<0.05)。术后感染或发热、子宫复旧率、月经情况和基础性激素水平比较,2组差异无统计学意义(均P>0.05)。结论 B-Lynch缝合术和宫腔纱条填塞可以有效治疗剖宫产术中的大出血,B-Lynch缝合术具有出血少、手术时间短、术后并发症少等优点,对卵巢功能的影响与宫腔纱条填塞相似。Objective To compare the effects of B-Lynch suture and intrauterine gauze tampon-ade on postpartum hemorrhage （PPH）and ovarian function.Methods A retrospective analysis was performed in 59 patients who underwent ineffective conservative treatment for PPH,inclu-ding 36 patients who underwent B-Lynch suture （group A）and 23 patients who underwent intra-uterine gauze tamponade （group B）.The operation time,blood loss,response rate,and incidence of postoperative anemia,fever or infection were compared between the two groups.In addition,u-terine instauration rate,menstruation recovery （menstrual flow and menstrual cycle）,incidence of intrauterine adhesions and levels of E2,FSH,LH and LH/FSH were determined at 42 days after operation,within 1 year after operation,within 6 months after operation and during D1-D3 of the first postoperative menstrual cycle,respectively.Results Compared with B-Lynch suture,intrau-terine gauze tamponade decreased response rate （90.5% vs 97.2%,P 〈0.05）,prolonged opera-tion time [（154 ± 31）minutes vs （112 ± 36）minutes,P 〈 0.05],increased intraoperatve blood loss[（705±152）mL vs （564±112）mL,P 〈0.05]and 24-hour postoperative vaginal bleeding a-mount[（230±44）mL vs （115±32）mL,P 〈0.05],and reduced incidence of postoperative anemia （26.1% vs 33.3%,P 〈0.05）.There were no significant differences in postoperative infection or fever,uterine instauration rate,menstruation recovery and basic sex hormone levels between the two groups （P 〉0.05）.Conclusion B-Lynch suture and intrauterine gauze tamponade are effec-tive for PPH and have similar effects on ovarian function.However,B-Lynch suture can reduce B-Lynch suture,shorten operation time and decrease postoperative complications compared with in-trauterine gauze tamponade.

关 键 词：B-Lynch 缝合术 宫腔纱条填塞 产后出血 卵巢功能 

分 类 号：R719.8[医药卫生—妇产科学]