子宫下段多方位螺旋式缝合成形术在凶险性前置胎盘手术中的应用  

Multiposition spiral suture of the lower uterine segment： a new technique to control the intraoperative bleeding of pernicious placenta previa

作　　者：刘海意[1] 林星光[1] 乌剑利[1] 乔福元[1] 邓东锐[1] 曾万江[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院妇产科,武汉450052

出　　处：《中华妇产科杂志》2016年第10期754-758,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：国家科技支撑计划（2014BA105800）

摘　　要：目的探讨子宫下段多方位螺旋式缝合成形术在凶险性前置胎盘（PPP）手术止血中应用的可行性和安全性。方法选择2014年5月至2015年5月在华中科技大学同济医学院附属同济医院住院治疗的PPP产妇38例，行剖宫产术时彻底清除胎盘后，行子宫下段多方位螺旋式缝合成形术，以处理胎盘附着部位的术中急性大出血，部分辅以子宫动脉结扎术。对38例孕妇的临床资料进行分析。结果38例PPP产妇中合并胎盘植入者18例，占47％（18／38）；此法成功治疗38例产妇，其子宫颈管长度为（3．1±0．6）cm，其中4个区域均缝合者12例（32％，12／38）、缝合2—3个区域者23例（61％，23／38），3例（8％，3／38）仅缝合后壁区域；12例（32％，12／38）行单纯子宫动脉结扎术、3例（8％，3／38）行子宫动脉结扎＋COOK球囊放置术补充止血，无产后大出血或行髂内动脉栓塞术者；2例因术中大出血行子宫切除术，占5％（2／38）。38例产妇术中失血量平均为（1696±1397）ml，最多者4500ml，〉1500ml者16例（42％，16／38）；围手术期共发生3例血尿，占8％（3／38）。术后半年随访无一例出现远期并发症。结论子宫下段多方位螺旋式缝合成形术是1种简便易行、安全可靠的手术止血方法，既可有效地控制PPP术中大量出血、避免切除子宫，又可彻底清除胎盘、环状缩窄恢复子宫下段形态，有助于产后子宫复旧。Objective To explore the efficacy and safety of muhiposition spiral suture of the lower uterine segment, a new technique to control the intraoperative bleeding of pernicious placenta previa（PPP）. Methods From May 2014 to May 2015, 38 patients were diagnosed PPP in Tongji Hospital and cesarean sections were performed. After removing the placenta, muhiposition spiral suture was used when massive bleeding occurred, and bilateral descending branches of uterine artery ligation was conducted when necessary. Results 18 of the 38 PPP patients （47%,18/38） were diagnosed placenta accreta. The average cervical canal length of 38 PPP patients was （3.1±0.6） cm. There were 12 cases （32%, 12/38） with 4 regions sutured, 23 eases（61%, 23/38）with 2-3 regions sutured and 3 cases （8%, 3/38） with only posterior wall area sutured. Twelve eases （32%, 12/38） underwent uterine artery ligation, 3 cases（8%, 3/38） underwent uterine artery ligation and COOK balloon. None of them was postpartum hemorrhage or performing internal iliac artery embolization. Two patients received hysterectomy. The average blood loss in the operation was （ 1 696± 1 397） ml. In 16（42%,16/38） patients, the blood loss exceeded 1 500 ml, and the heaviest one was 4 500 ml. Three patients had haematuria in the first 3 days after the operation. No complication was found in 6 months after the operation. Conclusions The muhiposition spiral suture technique is a simple, safe and effective way to control the massive bleeding in the cesarean section of PPP patients. It is also beneficial for the recovery of the uterus.

关 键 词：前置胎盘 妇科外科手术 缝合技术 止血 手术 

分 类 号：R719[医药卫生—妇产科学]