子宫网压缝合术在难治性产后出血中的初步应用  

The Initial Application of a Uterine Netlike Compression Suture in Intractable Postpartum Hemorrhage

作　　者：王晨笛[1] 李莉[1] 李南 徐世康[1] 刘莉[1] 刘颖[1] 卢小红[1] 李莉(大)[1] 韩倩[1] 李莉琼[1] 刘帅 雷颖[3] 尹学琼 何丛妍 

机构地区：[1]成都市第五人民医院,四川成都611130 [2]成都市妇女儿童中心医院,四川成都610091 [3]成都市温江区妇幼保健院,四川成都611130 [4]四川省崇州市妇幼保健院,四川崇州611230 [5]四川省大邑县人民医院,四川大邑611300

出　　处：《实用妇产科杂志》2016年第2期138-143,共6页Journal of Practical Obstetrics and Gynecology

基　　金：四川省卫生和计划生育委员会科研课题(编号:150023);成都市科学技术局成都市科技惠民技术研发项目(编号:2014-HM01-00330-SF);成都市卫生局卫生科研重大攻关项目(编号:2014044)

摘　　要：目的：探讨子宫网压缝合术在难治性产后出血治疗中的应用价值。方法：回顾分析子宫网压缝合术对5例难治性产后出血患者的临床治疗,评价手术疗效及手术安全性。结果：经子宫按摩、促宫缩药物注射、宫腔纱条填塞、子宫动脉结扎或B-Lynch缝合等措施处理仍无法止血的5例宫缩乏力性产后出血患者,行子宫网压缝合术后,子宫活动性出血5~10分钟内停止,观察30分钟阴道无明显流血关腹,均成功止血并保留子宫。术后5天垂体激素、甲状腺激素、肾上腺激素及女性激素各项数值均在正常范围;磁共振成像（MRI）检查：术后4天宫壁见散在点状信号,未见宫腔积液;术后46天宫壁肌层信号均匀,宫内膜线清晰。超声检查：术后42天子宫前后径3.5~4.5 cm,宫壁肌层回声均匀,复旧形态良好。宫腔镜检查：术后5个月,宫腔无粘连,内膜形态正常,输卵管开口清晰。随访：例5在哺乳期,其余病例停止哺乳后1~2个月月经恢复正常;例2术后20个月再次妊娠,术后29个月经剖宫产诞下1健康女婴。结论：对经子宫按摩、促宫缩药物注射、宫腔纱条填塞、子宫动脉结扎及B-Lynch缝合等措施处理仍无法止血的宫缩乏力性产后出血患者,子宫网压缝合术治疗安全有效,可以考虑作为治疗难治性产后出血的一种止血方式。Objective： To investigate the clinical value of Chendi netlike compression suture（ CNCS） for treating intractable postpartum hemorrhage（ PPH）. M ethods： The treatments of 5 cases of intractable postpartum hemorrhage by CNCS were retrospectively analyzed,and the efficacy and security were evaluated and observed.Results： The active bleeding stopped within 5- 10 min after the CNCS was implemented in the 5 women who were firstly treated with uterus massage,contraction drugs,intrauterine gauze tamponade,uterine artery ligation and / or B-Lynch suturing but to no avail. No obviously virginal bleeding was observed in 30 min before abdomen closure. All uterus were reserved. Hormones levels： pituitary hormone,thyroid hormone,adrenal hormone and female sex hormone were normal on the fifth postoperative day. MRI： scattered punctiform signals in the uterine wall and no endometrial cavity fluid on the fourth day; uniform signals of the muscle layer of the uterus and clear line of endometrium 46 days later. Ultrasonic inspection： the anteroposterior dimension of the uterus was 3. 5- 4. 5 cm,the echo of the muscle layer was even and the uterus reconversion was fine in 42 days. Hysteroscope inspection：no intrauterine adhesion,normal endometrium and clear openings of the fallopian tubes 5 months later. Follow-up：one case（ no. 5） was still in lactation,the other four resumed normal menstruation after delectation. Case no. 2 regestated 20 months later and gave birth to a healthy girl infant safely in 29 months by uterine-incision delivery.Conclusions： For cases failed to arrest bleeding by uterus massage,contraction drugs,intrauterine gauze tam ponade,uterine artery ligation and B-Lynch suturing,the CNCS is effective,which may be considerated for the treatment method for the intractable PPH.

关 键 词：难治性产后出血 产科急救 子宫网压缝合术 

分 类 号：R714.462[医药卫生—妇产科学]