子宫下段横形环状压迫缝合术治疗中央性前置胎盘剖宫产后出血

Clinical Research on Transverse Annular Compression Sutures in the Lower Uterine Segment to Control Postpartum Hemorrhage at Cesarean Delivery for Complete Placenta Previa

目的:探讨子宫下段横形环状压迫缝合术(TACS)治疗中央性前置胎盘剖宫产时子宫下段胎盘剥离面出血的止血效果。方法:回顾性分析2006年1月—2010年12月满足研究入选条件的中央性前置胎盘患者60例,分为宫腔纱条填塞组(UP组,24例)和TACS组36例。比较两组出血量、干预时间、有效率等。结果:①UP组和TACS组分娩时妊娠周、新生儿出生体质量、前壁胎盘比例和胎盘粘连比例差异均无统计学意义(均P>0.05)。②两组缩宫素使用量差异无统计学意义(P>0.05),但是UP组的欣母沛使用量显著多于TACS组(P<0.05)。③两组产前出血比例、产前出血量差异无统计学意义;但UP组干预前出血量、干预时出血量、干预后出血量和剖宫产期间总出血量显著高于TACS组,差异有统计学意义(均P<0.01)。UP组输血百分比显著高于TACS组(P<0.01),输血量也多于TACS组(P<0.05)。④UP组干预时间显著长于TACS组(P<0.01);两组止血成功率分别为91.7%和97.2%,差异无统计学意义(P>0.05)。⑤TACS组的抗生素使用时间和术后住院时间显著短于UP组(均P<0.01)。结论:TACS是治疗中央性前置胎盘剖宫产时子宫下段胎盘剥离面出血的简便、有效、快速的方法。

Objective：To evaluate the efficacy of transverse annular compression sutures（TACS）in the lower uterine segment in achieving homeostasis to control bleeding during cesarean delivery in women with complete placenta previa（CPP）. Methods：Retrospectively analyze 60 cases who met the inclusion criteria with CPP during 2006,January to 2010,December. All the patients were divided into two groups：subsequent administration of either uterine packing（UP）or TACS. Blood loss,intervention time,and clinical efficacy were compared. Results：①There was no statistic difference between the UP group and the TACS group in gestational age at delivery,birth weight,the proportion of anterior placenta and the incidence of placenta accreta（P0.05）. ②No difference was found between the groups in oxytocin dose（P0.05）. However,carboprost usage amount was much more in the UP group（P0.05）. ③No difference was found between the groups in percentage of ante partum hemorrhage and the blood loss of antepartun. But there was greater blood loss in the UP group compared with the TACS group before the intervention,during the intervention,after the intervention,and throughout the cesarean delivery procedure（P0.01）. The percentage and quantity of blood transfused was also significantly higher in the UP group than in the TACS group（P0.05 or P0.01）. ④The time taken to perform the uterine packing was significant longer than the time taken to perform TACS（P0.05）. The success rates were 91.7% and 97.2% for UP and TACS,respectively（P0.05）. ⑤Antibiotics using time and post-operative hospitalization time was significantly shorter in the TACS group than in the UP group（P0.01）. Conclusions：TACS appears to be a simple,effective and quick method in achieving homeostasis in women with CPP during cesarean delivery.