子宫下段间断缝合防治完全性前置胎盘产后出血临床研究

Clinical study on prevention of postpartum hemorrhage of complete placenta previa with interrupted suture the lower uterine segment

目的:探讨应用子宫下段间断缝合法防治完全性前置胎盘产后出血的临床效果。方法:选择2007年7月～2011年2月我科收治的完全性前置胎盘41例,随机分为两组。观察组20例,在剖宫产术中胎盘剥离后采用子宫下段间断缝合法防治胎盘剥离面出血,必要时行子宫动脉下行支结扎。对照组21例,在剖宫产术中采用常规方法止血。观察两组止血效果。结果:观察组在平均出血量[(675.00±212.07)ml vs(1 547.63±761.32)ml](P<0.05)、平均手术时间[(49.75±15.14)min vs(80.22±40.01)min](P<0.01)、输血率(20.00%vs 52.38%)(P<0.05)、子宫切除率(0 vs 28.57%)(P<0.01)方面明显优于对照组,差异均有统计学意义。产后42～60 d复查子宫复旧及晚期产后出血情况,观察组19例(95.00%)子宫复旧良好,对照组14例(93.33%)子宫复旧良好,两组均无产褥感染、晚期产后大出血发生。两组比较,差异无统计学意义(P>0.05)。结论:该缝合方法是防治完全性前置胎盘产后出血的有效方法,它具有操作简便、易于掌握、止血迅速、效果可靠、能降低输血率、保留子宫等优点,值得推广应用。

Objective： To evaluate the clinical effects on prevention of the postpartum hemorrhage of complete placenta previa with interrupted suture the lower uterine segment in cesarean section.Methods： 41 patients with complete placenta previa in our department from July 2007 to February 2011 were randomly divided into two groups,20 cases were chosen as the observation group,they were performed interrupted suture at lower routine segment to control the bleeding of surface of placental separation.It was noted that the descending uterine artery ligation was conducted if necessary between this group.For the control group,21 patients were performed routine methods during cesarean section to prevent postpartum hemorrhage.The effect was observed.Results： There were significant differences about the average blood loss volume [（675.00±212.07） ml vs（1547.63±761.32） ml]（P〈0.05）,mean operative duration [（49.75±15.14） min vs（80.22±40.01） min]（P〈0.01）,transfusion rates（20.00% vs 52.38%）（P〈0.05）,hysterectomy rates（0 vs 28.57%）（P〈0.01） in the observation group and the control group.The postpartum examination in 42-60 days showed that 95.00% of the observation group（19 cases） were in good conditions for the involution of uterus whereas the percentage was 93.33% of the control group（14 cases）.Both of the two groups didn′t appear the puerperal infection and the postpartum hemorrhage.There was no statistical difference between the two groups（P〉0.05）.Conclusion： The method of interrupted suture at lower routine segment is a safe,effective technique for preventing the postpartum hemorrhage of complete placenta previa.It has the benefits of the easy operation,rapidly mastering,quick hemostatic,high reliability,low transfusion rate and the preservation of uterus.It’s worthy of promotion.