术前预置髂内动脉球囊联合子宫下段环形缝扎在凶险性前置胎盘致产后出血中的应用

The Application of Annular Suture in the Treatment of Postpartum Hemorrhage Caused by Dangerous Placenta Previa

目的研究预置髂内动脉球囊联合子宫下段环形缝扎对于凶险性前置胎盘导致的产后出血的治疗效果,以及实施该手术对于患者的远期影响.方法选择2015年1月1日至2017年3月31日于云南省第二人民医院进行剖宫产的凶险性前置胎盘的患者,对其中应用预置髂内动脉球囊联合子宫下段环形缝扎术中处理的研究组22例患者作为研究组,将术中未使用子宫下段多重环形缝合法处理,但进行了预置髂内动脉球囊的18例凶险性前置胎盘患者作为对照组的临床资料进行回顾性分析.结果 22例患者的术中平均出血量(1 329.54±290)m L.所有患者术中未出现周围器官损伤等手术并发症,1例子宫切除.术后平均住院日5.23 d.术后3个月随访彩超检查,子宫形态良好.对照组18例患者术中平均出血量(1451.11±311)m L出血量均明显高于研究组,差异有统计学意义(P<0.05).对照组中2例子宫切除,子宫保留情况差异有统计学意义(P<0.05).结论预置髂内动脉球囊联合子宫下段环形缝扎对于凶险性前置胎盘导致的术中子宫出血的治疗效果较好.

Objective To study the effect of pre-operative internal iliac artery capsule combined with the lower segment of the uterus with annular suture on the treatment of postpartum hemorrhage caused by dangerous placenta previa and the long-term effect of the operation.Methods from January 1,2015 to March 31,2017,the second people's Hospital of Yunnan province for Cesarean danger in placenta of patients using preset internal iliac artery balloon combined with lower uterine segment ring-shaped suture in the treatment of 22 cases of patients as research group,Lower uterine segment multiple is not used in loop suture for treatment,but has a preset internal iliac artery balloon 18 cases of dangerous patients with placenta previa,as retrospective analysis clinical data of the comparison group.Results Mean blood loss in 22 patients 1329.54±290 ml.Does not occur in all patients around organ damage and other complications.1 examples of hysterectomy.5.23 days postoperative average hospital stay.After 3 months of follow-up ultrasound,uterus shape well.In 18 patients in the control group average blood loss 1451.11±311 ml of blood loss were significantly higher in the study group,there was a statistically significant difference(<0.05).2 examples of hysterectomy in the control group.Uterine reservations there was statistically significant(<0.05).Conclusion Combined preset internal iliac artery balloon uterus circular suturing for the dangerous result of placenta previa with placenta accreta intraoperative uterine bleeding for better effect.