剖宫产术中宫颈捆扎加正方形缝合预防中央性前置胎盘产后出血

Cervical Strapping and Square Suture in Prevention of Postpartum Hemorrhage of Central Placenta Previa during Cesarean Section

目的探讨剖宫产术中宫颈捆扎加正方形缝合预防中央性前置胎盘产后出血的效果。方法 研究组中央性前置胎盘34例,在暂时阻断子宫血流下行子宫下段和（/或）宫颈内口局部正方形缝合以预防中央性前置胎盘剖宫产后大出血,必要时加行子宫动脉下行支结扎。26例中央性前置胎盘患者为对照组,采用常规方法预防产后出血。结果研究组在平均出血量、平均手术时间、宫腔填纱率、子宫切除率以及产褥病率方面均明显优于对照组（P〈0.05或P〈0.01）。术后56-60 d B超检查两组子宫复旧情况,研究组32例（94.1%）子宫复旧良好,对照组20例（90.0%）恢复正常,组间比较无统计学差异（P〉0.05）。结论该方法具有安全、止血快、效果可靠、能保留子宫等优点,是预防中央性前置胎盘剖宫产出血的可靠方法。

Objective To assess the effect of cervical binding and square suture in prevention of postpartum hemorrhage of central placenta previa during cesarean section.Methods 34 parturients with central placenta previa were regard as study group.They were performed square suture at lower uterine segment and（or） inner-cervical oral to prevent postpartum hemorrhage under uterine blood flow blocked temporarily,and were supplemented with ligation of ramus descendens of uterine artery if necessary.26 parturients with central placenta previa were regard as control group,and were performed routine measures to prevent postpartum hemorrhage.Results The average blood loss volume,mean operative duration,rate of intrauterine packing with gauze,hysterectomy rate and postpartum infective rate was significant lower in study group than those in control group,the concrete data was（485.1±68.0） ml vs.（881.3±15.1） ml,（51.2±6.1） minutes vs.（75.4±9.3） minutes,0 vs.19.2%,0 vs.15.4% and 5.9% vs.30.8%,respectively（P〈0.05 or P〈0.01）.34 cases of study group and 22 cases of control group were followed up.The B-ultrasonography exam showed involution of uterus was well in 32 cases（94.1%） of study group and 20 cases（90.9%） of control group,and there was no statistical difference between two groups（P〈0.05）. Conclusion The method of cervical binding and square suture is a safe,effective and reliable technique for preventing of postpartum hemorrhage of central placenta previa in cesarean section with advantages as fast hemostasis and preservation of uterus.