子宫下段前后缩窄加血管纵横阻断缝合技术在前置胎盘合并重型植入手术中的应用  

Evaluation of Vessel Interruption and Perfoliate Compression Suture for Placenta Previa Complicated with Increta and Percreta

作　　者：陈运山[1] 赵扬玉[1] 王妍[1] 种轶文[1] 盛晴[1] 

机构地区：[1]北京大学第三医院妇产科,北京100083

出　　处：《中国微创外科杂志》2017年第9期794-797,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：国家科技支撑计划课题(编号:2014BAI05B05);北京大学第三医院种子基金(编号:Y85436-01)

摘　　要：目的探讨子宫下段前后缩窄加血管纵横阻断缝合技术(vessel interruption and perfoliate compression suture,VIP-CS)在前置胎盘合并重型植入手术中的应用效果。方法 2004年1月~2014年12月,对46例前置胎盘合并重型植入于剥离胎盘后尝试保留子宫,2012年之前24例采用传统方法止血(传统组),2012年之后22例采用VIP-CS缝合方法(VIP-CS组),对比2组术中出血量、手术时间、保留子宫率。结果 VIP-CS组子宫保留成功率86.4%(19/22),明显高于传统组[50.0%(12/24)](χ~2=6.907,P=0.009);VIP-CS组术中严重大出血(>4000 ml)发生率为27.3%(6/22),明显低于传统组[58.3%(14/24)](χ~2=4.506,P=0.034)。在保留子宫成功病例中,VIP-CS组手术时间[(152±65)min]与传统组[(147±108)min]无明显差异(t=0.162,P=0.873)。结论前置胎盘合并重型胎盘植入手术中应用VIP-CS简易,高效,安全。Objective To evaluate the effects of vessel interruption and perfoliate compression suture （VIP -CS ） for plac en ta previa complicated with increta and percreta to control bleeding during cesarean section delivery. Methods There were 46 patients with diagnosis of placenta previa complicated with increta and percreta from January 2004 to December 2014 in our hospital. A total of 22 cases （ after 2012） receiving VIP-CS were included in the research group, while the other 24 cases （before 2012） without VIP-CS were regarded as the control group. The blood loss, operative time, and uterine preservation rate were compared between the two groups. Results The uterine preserving success rate was 86. 4% （19/22） in the re sea rch group and 50.0% （12/24） in the control group, which was statistically different （ X2 = 6. 907 , P = 0. 009 ） . The incidenc e of intraoperative severe blood loss （ 〉 4 0 00 m l） was 27. 3% （6/22） in the research group, which was significantly less than the control group [58.3% （ 14/24） , = 4. 506, P =0. 034 ] . The surgery time was not significantly different between the two groups [ （ 152 ± 65 ） min vs. （ 147 ± 108 ） min, J = 0. 162 , P = 0.873]. Conclusion The VIP-CS is a s imp le , efficient , and safe hemostasis method to control bleeding for placen ta previa complicated with increta and percreta.

关 键 词：缝合技术 前置胎盘 胎盘植入 保留生育功能 

分 类 号：R714.2[医药卫生—妇产科学]