子宫下段螺旋式同心圆缝合术在前置胎盘(并植入)手术中的应用效果  

Effect of spirally concentric suture of lower uterus segment on patients with placenta previa and placental implantation

作　　者：孙宇[1] 杨奕梅 范薇[1] 康玮[1] 杨丽娟 李菱[1] 张雯[2] SUN Yu;YANG Yimei;FAN Wei;KANG Wei;YANG Lijuan;LI Ling;ZHANG Wen(Department of Obstetrics,Kunming Maternal and Child Health Care Hospital,Kunming 650031,Yunnan,China;Department of Gynecology,Kunming Maternal and Child Health Care Hospital,Kunming 650031,Yunnan,China)

机构地区：[1]昆明市妇幼保健院产科,云南昆明650031 [2]昆明市妇幼保健院妇科,云南昆明650031

出　　处：《贵州医科大学学报》2021年第12期1452-1457,共6页Journal of Guizhou Medical University

基　　金：云南省科技厅科技计划项目(2018FH001-088);昆明市科技计划项目(2019-1-S-25318000001528)。

摘　　要：目的探索子宫下段螺旋式同心圆缝合术在前置胎盘(并植入)手术中的效果。方法106例前置胎盘(并植入)患者分为对照组(n=50,常规缝合子宫下段出血部位)和观察组(n=56,子宫下段出血部位螺旋式同心圆缝合术);比较2组患者临床治疗效果、恶露持续时间、手术时间、住院时间、住院费用、子宫复旧率、子宫切除率,比较2组患者术中及术后2 h、24 h出血量,比较2组患者术前及术后第1天、第3天、第5天的血红蛋白(Hb)、纤维蛋白原(FIB)及D-二聚体含量,比较2组患者术后住院期间产褥感染、切口感染、肠梗阻、腹痛发生率。结果2组患者子宫复旧率、子宫切除率比较,差异无统计学意义(P>0.05);观察组患者各时间段出血量少于对照组,差异有统计学意义(P<0.05);观察组手术时间、恶露持续时间、住院时间短于对照组,差异有统计学意义(P<0.05);观察组住院费用少于对照组,差异有统计学意义(P<0.05);2组患者术后第1天、第3天、第5天的D-二聚体、FIB、Hb水平均较同组术前有所降低,差异有统计学意义(P<0.05);术后第3天和第5天开始观察组D-二聚体、FIB、Hb水平高于对照组,差异有统计学意义(P<0.05);观察组术后并发症总发生率低于对照组,差异有统计学意义(χ^(2)=7.102,P=0.008)。结论子宫下段螺旋式同心圆缝合术对前置胎盘(并植入)患者的止血效果好于常规缝合下段止血术。Objective To explore the effect of spirally concentric suture of the lower uterus on patients with placenta previa and placental implantation.Methods A total of 106 patients with placenta previa(and implantation)were divided into control group(n=50,conventional suture)and observation group(n=56,spirally concentric suture).Therapeutic effect,lochia duration,operation time,hospital stay,hospitalization cost,uterine involution rate,and hysterectomy rate were compared in these two groups.The bleeding volumes were compared between two groups during the operation,at 2 h and 24 h after the operation.The levels of hemoglobin(Hb),fibrinogen(FIB),and D-dimer were compared between two groups before the operation,on 1st day,3rd day,and 5th day after operation.The incidence rates of puerperal infection,incision infection,intestinal obstruction,and abdominal pain were compared between two groups during hospitalization.Results There were no significant differences in uterine involution rate and hysterectomy rate between two groups(P>0.05).The bleeding volumes of patients were less in observation group than those in control group at each time point(P<0.05).The operation time,lochia duration,and hospitalization time were shorter in observation group than those in control group(P<0.05).Observation group spent less hospitalization expenses than control group(P<0.05).The levels of D-dimer,FIB,and Hb were reduced on 1 st day,3 rd day,and 5 th day after the operation relative to before the operation in two groups(P<0.05).On 3 rd and 5 th days,the levels of D-dimer,FIB,and Hb in observation group were higher than those in control group(P<0.05).The total incidence rate of postoperative complications in observation group was lower than that in control group(χ^(2)=7.102,P=0.008).Conclusion The lower uterine spiral concentric circle suture stopped better in patients with placenta previa(and implantation)than in conventional lower suture hemostasis.

关 键 词：螺旋式同心圆缝合术 前置胎盘 并发症 出血量 凝血功能 恶露 止血术 

分 类 号：R615[医药卫生—外科学]