阔韧带内子宫动脉主干结扎术于前置胎盘术中止血的临床研究  

Clinical study of endoscopic ligation of endoluminal ligament in the placenta of placenta

作　　者：杨敏[1] 陈英[1] 罗权[1] YANG Min CHEN Ying LUO Quan(Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Jiujiang City in Jiangxi Province, Jiujiang 332000, Chin)

机构地区：[1]江西省九江市妇幼保健院妇产科,江西九江332000

出　　处：《中国现代医生》2017年第24期4-7,F0003,共5页China Modern Doctor

基　　金：江西省九江市科技计划项目(2016214)

摘　　要：目的探讨阔韧带内子宫动脉主干结扎术于前置胎盘术中止血的疗效。方法选择2016年1月~2017年5月我院收治的233例前置胎盘孕妇为研究对象,根据病情、前置胎盘分型综合评估分为前置胎盘重型(中央性、凶险型前置胎盘)与轻型(部分性、边缘性前置胎盘),按前置胎盘术中止血术式不同随机分为研究组和对照组;研究组采用首选阔韧带内子宫动脉主干结扎术止血,对照组采用首选子宫动脉上行支、下行支结扎术止血。比较两组患者术中出血量、手术时间、输血量、术后24 h内出血量、产褥感染、产妇预后的差异。结果重型前置胎盘类,研究组术中出血量、术后24 h内出血量、手术时间、输血量及并发症显著优于对照组(P<0.01或P<0.05);前置胎盘轻型类,研究组输血量少于对照组,差异有统计学意义(P<0.05),但手术时间、术中出血量、术后24 h内出血量及并发症两组比较无差异。结论阔韧带内子宫动脉主干结扎术是一种安全、有效、简单易行,能普遍适用于前置胎盘患者剖宫产术中止血方法,可提高抢救、治疗效果,改善产妇预后。Objective To investigate the curative effect of endoscopic esophageal ligation of the ligamentous hgamenturn during the placenta previa. Methods 233 patients with placenta previa from January 2016 to May 2017 were selected as the study subjects. According to state of the illness and the comprehensive evaluation of placenta previa, the placenta previa severity（central, risky placenta previa）and light （partial, marginal placenta previa）, according to the different operations in placenta previa were randomly divided into study group and control group;the study group using the preferred ligamentum umbrella arterial trunk ligation, the control group using the preferred uterine artery branch, descending branch ligation. The blood loss, operation time, blood transfusion, blood loss within 24 hours, puerperal infection and maternal prognosis were compared between the two groups. Results Of the placenta previa severity, the volume of bleeding, the amount of blood loss after surgtry 24 h, operation ti^e, blood transfusion and complication in the study group were significantly better than those in the control group,the differences were statistically significant（P〈0.01 or P〈0.05）. Of the placentcl previa light, blood transfusion was lower in the placenta, the differece was statistically significant（P〈0.05）. There were no significant differences in the operation time, the volume of bleeding, the amount of blood loss after surgery 24 h and the complication between the two groups. Conclusion Uterine artery trunk ligation in the broad ligament is a safe, effective and simple method. It can be widely applied to the hemostasis method of cesarean section in placenta previa, which can improve the rescue and treatment effect and improve the prognosis of maternal.

关 键 词：子宫动脉主干结扎术 子宫动脉上行支结扎术 子宫动脉下行支结扎术 前置胎盘 止血 

分 类 号：R719[医药卫生—妇产科学]