难治性产后出血子宫网压缝合术治疗的多中心临床有效性观察  

Clinical Observation of the Efficacy of the Uterine Net-Like Compression Suture for Treating Intractable Postpartum Hemorrhage

作　　者：王晨笛 朱天行 雷颖 李莉[2] 李南 赵萍 钟英 王成英 WANG Chendi;ZHU Tianxing;LEI Ying(Department of Obstetrics and Gynecology,Wenjiang District Maternal and Child Health Hospital of Chengdu,Chengdu Sichuan 611130,China)

机构地区：[1]成都市温江区妇幼保健院妇产科,四川成都611130 [2]成都市第五人民医院妇产科,四川成都611130 [3]成都市妇女儿童中心医院产前诊断科,四川成都610091 [4]四川省邛崃市妇幼保健院妇产科,四川邛崃611530 [5]成都市金堂纺织妇产医院妇产科,四川金堂610404 [6]西南兵工成都医院妇产科,四川成都611700

出　　处：《实用妇产科杂志》2024年第11期923-927,共5页Journal of Practical Obstetrics and Gynecology

基　　金：成都市卫生健康委员会科研课题(编号:2023623)。

摘　　要：目的:探讨子宫网压缝合术在难治性产后出血(PPH)治疗中的应用价值。方法:回顾性分析2015年1月至2023年3月成都市6家妇儿医联体医院84例难治性PPH患者保守性手术治疗资料,按手术方法分为2组:B-Lynch缝合术(对照组)41例,子宫网压缝合术(观察组)43例。观察2组临床治疗有效性,对比2组围手术期相关指标及临床治疗结局。结果:①对照组31例成功止血并保留子宫,治疗有效率75.61%,观察组42例成功止血并保留子宫,治疗有效率97.67%,2组比较差异有统计学意义(P<0.01)。②术中各项诊断、术前出血量,2组比较差异均无统计学意义(P>0.05);术中、术后2 h出血量观察组低于对照组,差异有统计学意义(P<0.01);术后输血观察组低于对照组,差异有统计学意义(P<0.01);术后转ICU、住院天数观察组均低于对照组,差异有统计学意义(P<0.01)。③随访时间10~48个月,73例保留子宫患者术后12个月内均恢复月经,对照组13例(41.94%)出现月经量减少及周期改变,观察组6例(14.29%)出现月经量减少及周期改变,2组差异有统计学意义(P<0.01);对照组5例(16.13%)有后续妊娠,观察组12例(28.57%)有后续妊娠,2组差异无统计学意义(P>0.05)。结论:子宫网压缝合及B-Lynch缝合术对难治性PPH治疗均具有良好的临床疗效,子宫网压缝合术在术中、术后出血量,以及术后输血、住院天数方面具有较好治疗优势。子宫网压缝合术对医疗器械及材料无特殊要求,对医疗条件有限的基层产科具有重要推广应用价值。Objective:To explore the application value of uterine net-like compression suture in postpartum hemorrhage(PPH).Methods:The data of 84 refractory PPH patients from six hospitals specialized in children and women in Chengdu from January 2015 to March 2023 were retrospectively analyzed.They were divided into two groups according to the surgical methods:41 cases of B-Lynch suture(control group)and 43 cases of uterine net-like compression suture(observation group).The clinical efficacy of the two methods was observed,and the perioperative indicators and clinical outcomes were compared between the two groups.Results:①31 cases in the control group and 42 cases in the observation group,were successfully hemostatic and retained the uterus,with effective rates of 75.61%and 97.67%,respectively.The difference was statistically significant(P<0.01).②There were no significant differences in the rates of all preoperative diagnosis and preoperative blood loss between the two groups(P>0.05);in the observation group,the intraoperative and 2 h postoperative blood loss,the units of postoperative blood transfusion,the incidence rate of requiring postoperative intensive care and the hospitalization days,were less than those in the control group(P<0.01).③During a follow-up period of 10-48 months,all 73 patients without hysterectomy recovered menstrual cycles within 12 months after the surgery.Thirteen cases experienced reduced menstrual flow with cycle changes in the control group(41.94%),while 6 cases experienced in the observation group(14.29%),and the difference was statistically significant(P<0.01);5 cases(16.13%)had subsequent pregnancy in the control group,while 12 cases(28.57%)had in the other,with no significant difference(P>0.05).Conclusions:The two uterine sutures for refractory PPH have both achieved good clinical curative effects,and the uterine net-like compression suture shows therapeutic advantages on intraoperative and postoperative blood loss,postoperative blood transfusion,and hospitalization days.The uterine ne

关 键 词：难治性产后出血 B-LYNCH缝合术 子宫网压缝合术 有效性观察 

分 类 号：R714.461[医药卫生—妇产科学]