宫体缝合术在剖宫产术中出血的临床疗效及对患者远期生育力的影响  

Uterine stapling sutures in the treatment of primary postpartum hemorrhage during Cesarean section and impact on long-term fertility

作　　者：王建芳[1] 徐秋莲[1] 朱敏[1] WANG Jianfang;XU Qiulian;ZHU Min(Jinhua people's hospital,Zhejiang 321000,China)

机构地区：[1]浙江省金华市人民医院,金华321000

出　　处：《浙江创伤外科》2023年第5期849-853,共5页Zhejiang Journal of Traumatic Surgery

摘　　要：目的 探讨宫体“订书针式”缝合术治疗剖宫产术中出血的疗效及对远期生育力、再次妊娠结局的影响。方法 选取2018年1月至2018年12月金华市人民医院妇产科剖宫产术中产后出血的60例患者纳入研究。经常规处理(按摩子宫及促宫缩药物的应用)无效后行宫体“订书针式”缝合术30例,为研究组;经常规处理后未行宫体“订书针式”缝合术30例,为对照组。对产妇进行随访,对比研究者与对照组术后月经恢复情况及术后再妊娠结局。结果 研究组术中出血量略多于对照组[(992.33±242.84) vs.(826.67±115.20),t=3.376,P<0.01]。研究组24 h总出血量明显少于对照组[(1170.67±304.27) vs.(1393.67±507.69),t=-2.064,P<0,05]。研究组术后血红蛋白值高于对照组[(102.27±10.26) vs.(90.57±13.35),t=3.807,P<0.01]。研究组输血率和子宫动脉栓塞率分别为20%(6/30)、3.3%(1/30),均低于对照组[分别50%(15/30)、20%(6/30)](χ^(2)值分别为5.934和4.043,P均<0.05)。研究组住院天数短于对照组[(4.37±0.86) vs.(5.10±1.12),t=-2.899,P<0.05]。研究组患者恶露持续时间、术后首次月经恢复时间、术后首次月经量、恢复正常月经量所需的次数、产后月经周期与对照组无明显差别(P>0.05)。研究组双侧子宫动脉阻断指数、收缩期峰值与舒张末期血流速度比值与对照组无明显差别(P>0.05)。30例患者中妊娠8例,均自然受孕,其中足月手术分娩1例,2例处于妊娠期,另外因意外妊娠而行人工流产者5例。结论 宫体“订书针”缝合术治疗剖宫产术中出血简单、安全、高效,不影响子宫恢复,术后再次妊娠者结局良好。Objective To investigate the effects of stapling sutures for postpartum hemorrhage during cesarean section and its influence on long-term fertility and next pregnancy outcome.Methods 60 cases of postpartum hemorrhage in cesarean section in our hospital from January2018 to December 2018 were selected.The active bleeding stopped after uterine stapling sutures was implemented in 30 cases who were firstly treated with uterus massage and contraction drugs but no available(as the observational group),and another 30 cases of postpartum hemorrhage without the u-terine stapling sutures were defined as the control group.Follow-up was carried out to assess postoperative menstruation and subsequent pregnancy outcomes between the two groups.Results The estimated blood loss during the operation in the observational group was slightly more than in the control group[(992.33±242.84) vs.(826.67±115.20),t=3.376,P<0.01].The total blood loss during the first 24 hour after delivery in the observational group was lower than that in the control group[(1170.67±304.27) vs.(1393.67±507.69) t=-2.064,P<0.05].The postoperative hemoglobin values of the observational group were significantly higher than that of control [(102.27 ±10.26) vs.(90.57±13.35),t=3.807,P<0.01].The rates of blood transfusion and uterine artery embolization in the observational group was lower than the control group [20%(6/30) vs.50%(15/30),3.3%(1/30) vs.20%(6/30),P<0.05)].The length of stay in the observational group was shorter than that in the control group[(4.37 ±0.86) vs.(5.10±1.12),P<0.05].The differences of the lochia duration,the recovery time for the first period,the first menstrual flow(the amount of increase in the prenatal period multiples of measurement),the times needed to restore normal menstrual flow and the postpartum menstrual cycle between the two groups were not significant( P>0.05).Of the 30 patients,eight women were pregnant naturally,including one delivered by repeated cesarean section,two women were in pregnancy,and five women choose induce

关 键 词：剖宫产术 产后出血 缝合技术 月经 生育力 

分 类 号：R714.2[医药卫生—妇产科学]