B-lynch缝合术治疗及预防产后出血的临床效果

Effectiveness of B-lynch Suture in Treatment and Prevention of Postpartum Hemorrhage

目的初步评价B-lynch缝合术在治疗及预防产后出血中的有效性。方法回顾性分析北京协和医院2006年1月至2012年1月间施行B-lynch缝合术的20例患者的临床资料。其中,19例为剖宫产分娩时发生产后出血,应用促宫缩剂无效后施行B-lynch缝合术,1例为有促宫缩剂禁忌证的重症围产期心肌病患者为预防产后出血而行B-lynch缝合术。手术方法按经典B-lynch缝合术进行。对患者缝合前后出血量、住院期间情况、产后42d复查情况及远期月经情况、再次妊娠情况进行随访。结果 20例患者B-lynch缝合前出血量为200～4800ml,中位出血量为900ml;缝合后至产后24h出血量为50～200ml,中位出血量为100ml。17例患者单纯行B-lynch缝合后即达到较好的止血效果,3例出血严重患者在缝合后出血有所减少,但仍加用了子宫动脉缝扎术和(或)子宫动脉栓塞术。所有患者术后及产褥期复诊均恢复良好;远期随诊有2例月经量减少,1例继发不孕。结论 B-lynch缝合术是一项简单可靠、并发症少的产后出血保守性手术治疗方法。

Objective To evaluate the effectiveness of B-lynch suture in treatment and prevention of post- partum hemorrhage. Methods The clinical data of 20 Cesarean section cases who were admitted to our department from January 2006 to January 2012 were retrospectively analyzed. B-lynch suture was placed in 19 patients due to postpartum hemorrhage and in 1 patient for preventing massive hemorrhage with oxytocin and prostaglandins contraindications. The effectiveness, uterine retracting, and other complications were investigated during the follow-up. Results The amount of bleeding before and 24 hours after B-lynch suture were 200-4800 ml （ median ： 900 ml） and 50-200 ml （median： 100 ml）, respectively. Good hemostatic effect was achieved in 17 patients immediately after the suture procedure. In 3 severe cases, the blood loss declined after the procedure, while other interventions including uterine artery ligation and/or embolization were also applied. All patients recovered well after surgery and during the postpartum follow-up. No specific complication was found. Conclusion B-lynch suture is a simple and effective surgical technique that can be used to manage postpartum hemorrhage and avoid hysterectomy.