盆腔血管介入栓塞治疗难治性剖宫产后出血患者的效果研究  

Clinical observation on the effect of pelvic vascular embolization on the treatment of refractory postpartum hemorrhage after cesarean section

作　　者：郭上玮 刘敬 胡国敏 王洪斌 张华 李红站 李万松 GUO Shangwei;LIU Jing;HU Guomin(Department of Surgery,the No.4 People’s Hospital of Hengshui,Hebei,Hengshui 053000,China;不详)

机构地区：[1]河北省衡水市第四人民医院外科,053000 [2]河北省衡水市桃城区妇幼保健计划生育服务中心妇产科 [3]河北省衡水市桃城区妇幼保健计划生育服务中心麻醉科 [4]河北省衡水市桃城区疾病预防控制中心妇产科 [5]河北省衡水市第二人民医院麻醉科 [6]河北省衡水市中医院妇产科 [7]河北省衡水市妇幼保健院外科

出　　处：《河北医药》2023年第17期2644-2647,共4页Hebei Medical Journal

摘　　要：目的观察盆腔血管介入栓塞治疗难治性剖宫产后出血患者的疗效和安全性。方法选取2018年12月至2022年1月治疗的难治性产后出血患者240例,随机分为介入组和缝合组,每组120例。缝合组给予B-Lynch子宫压迫缝合治疗,介入组给予盆腔血管介入栓塞治疗。观察2组患者术中、术后情况,手术止血效果和术后并发症发生情况、复发情况。结果2组手术总时间和术中出血量差异无统计学意义(P>0.05);介入组止血操作时间明显长于缝合组(P<0.01);介入组患者的术后下床活动时间、住院时间均短于缝合组(P<0.01);介入组患者手术疗效明显优于缝合组(Z=2.430,P<0.05);介入组患者并发症发生率为15.00%略高于缝合组的10.00%,但差异无统计学意义(χ^(2)=0.690,P=0.41)。介入组患者复发率为0.83%低于缝合组的3.33%(P<0.05)。结论与子宫压迫缝合术相比,应用介入栓塞术对剖宫产产后出血患者进行治疗可以显著提高患者止血成功率,值得进一步研究。Objective To assess the clinical efficacy and safety of pelvic vascular embolization on the treatment of refractory postpartum hemorrhage after cesarean section.Methods A total of 240 cases of refractory postpartum hemorrhage after cesarean section treated from December 2018 to January 2022 were randomly divided into embolization group(n=120)and suture group(n=120).Patients in the embolization group and suture group were managed by pelvic vascular embolization and B-Lynch for uterine compression suture,respectively.The intraoperative and postoperative conditions,hemostatic effects,postoperative complications and recurrences of the two groups were observed and recorded to evaluate the therapeutic effect.Results There were no significant differences in the total operation time and intraoperative blood loss between groups(P>0.05).The hemostatic operation time in the embolization group was significantly longer than that in the suture group,while the off-bed activity time and length of stay were significantly shorter(all P<0.01).The surgical outcome was significantly superb in the embolization group than that in the suture group(Z=2.430,P<0.05).The incidence of complications in the embolization group(15.00%)was higher than that in the suture group(10.00%),but no significant difference was detectable(χ^(2)=0.690,P=0.41).The recurrent rate was significantly lower in the embolization group than that in the suture group(0.83%vs 3.33%,P<0.05).Conclusion Compared with uterine compression suture,interventional embolization can significantly improve the hemostasis effect on refractory postpartum hemorrhage after cesarean section,which is worthy of further study.

关 键 词：剖宫产 难治性产后出血 介入栓塞 子宫加压缝合 

分 类 号：R364.13[医药卫生—病理学]