子宫腔球囊填塞联合B-Lynch缝合术在双胎剖宫产产后出血中的应用效果  

Application effect of uterine B-Lynch suture combined with uterine balloon tamponade in postpartum hemorrhage during cesarean section of twins

作　　者：周俊俊[1] 吴晓丽 何小波 ZHOU Junjun;WU Xiaoli;HE Xiaobo(Department of Obstetrics,Women and Children's Hospital of Ningbo City,Ningbo 315012,China)

机构地区：[1]宁波市妇女儿童医院产科,浙江宁波315012

出　　处：《中国现代医生》2022年第5期64-68,共5页China Modern Doctor

基　　金：浙江省卫生健康科技计划项目(2021KY1057)。

摘　　要：目的探讨子宫腔球囊填塞联合B-Lynch缝合术(即子宫三明治缝合术)在双胎剖宫产产后出血中的应用效果。方法回顾性分析2010年1月至2017年4月宁波市妇女儿童医院产科收治的100例双胎行剖宫产分娩患者的临床资料,在100例双胎产后出血病例中,球囊放置组(对照组)50例,子宫腔球囊填塞联合B-Lynch缝合术(即子宫三明治缝合术,观察组)50例,对两组术前及术中相关资料及数据等情况进行对比分析。结果两组年龄、体质量指数、分娩孕龄、产次、既往剖宫产次数、前置胎盘、糖尿病、妊娠期高血压疾病、试管婴儿比较,差异均无统计学意义(P>0.05);观察组术中平均出血量少于对照组,但差异无统计学意义(P>0.05);两组在术后24 h内再出血量、术后1 h红细胞、血红蛋白、红细胞压积、总蛋白、白蛋白、凝血酶原时间、活化部分凝血活酶时间的差值比较,差异均无统计学意义(P>0.05)。观察组的子宫切除率、子宫动脉栓塞率、自体血回输例数、血浆输注例数均低于对照组,差异有统计学意义(P<0.05)。结论在双胎剖宫产过程中,发生产后出血的患者及时采用子宫三明治缝合术能够有效减少子宫出血量并明显降低子宫切除率,可有效保存子宫,值得临床推广。Objective To investigate the application effect of B-Lynch suture combined with uterine balloon tamponade(i.e.uterine sandwich suture)in postpartum hemorrhage during the cesarean section of twins.Methods The clinical data of 100 cases undergoing cesarean section of twins in the department of obstetrics in Women and Children’s Hospital of Ningbo City from January 2010 to April 2017 were analyzed retrospectively.Among 100 cases of twin with postpartum hemorrhage,there were 50 cases in the successful balloon placement group(the control group),and 50 cases in the uterine B-Lynch suture combined with uterine balloon tamponade(i.e.uterine sandwich suture,the observation group).The relevant data and data before and during the operation were compared and analyzed.Results There were no significant differences in age,body mass index,gestational weeks,parity,times of previous cesarean sections,placenta previa,diabetes,hypertensive disorder complicating pregnancy,and test-tube baby between the two groups(P>0.05).The average intraoperative blood loss was less in the observation group than that in the control group,with no statistically significant difference(P>0.05).There were no statistically significant differences in rebleeding within 24 hours after operation,erythrocyte within one hour after operation,hemoglobin,hematocrit,total protein,albumin,prothrombin time and activated partial thromboplastin time between the two groups(P>0.05).The hysterectomy rate,uterine artery embolization rate,the number of cases of autologous blood transfusion and plasma transfusion were lower in the observation group than those in the control group,with statistically significant differences(P<0.05).Conclusion Timely use of uterine sandwich suture can effectively reduce the amount of uterine bleeding and hysterectomy rate,and can effectively preserve the uterus of patients with postpartum hemorrhage after cesarean section of twins,which is worthy of clinical promotion.

关 键 词：子宫腔球囊填塞联合B-Lynch缝合术(即子宫三明治缝合术) 双胎 产后出血 剖宫产术 

分 类 号：R714[医药卫生—妇产科学]