子宫动脉上行支结扎在剖宫产术中大出血的临床疗效观察

Clinical effect observation on ligation of ascendant branch of uterine artery in massive hemorrhage during cesarean section

目的探讨子宫动脉上行支结扎在剖宫产术中大出血中的应用价值。方法选择剖宫产术中出血患者16例,将其分为研究组(10例)和对照组(6例),对照组患者先进行常规止血方法,无效时做子宫切除术;研究组患者在常规止血方法无效时立即进行子宫动脉上行支结扎术。观察两组止血效果和术后并发症及康复情况。结果研究组中有9例患者行双侧子宫动脉上行支结扎术,1例行单侧子宫动脉上行支结扎术,术中出血量、输血例数、子宫切除例数及平均住院天数均少于观察组(P<0.05)。研究组输血率为70.0%,切口感染率为10.0%,无一例行子宫切除术;观察组输血率为83.3%,切口感染率为16.7%,有1例行子宫切除;所有患者均无邻近脏器损伤。结论子宫动脉上行支结扎术应用于剖宫产术中止血有效、迅速,操作简单,无并发症,及早应用可避免增加输血和感染的发生,同时可以保全子宫,是在剖宫产术中出血一般治疗方法无效时的一项快速、有效而实用的产科技术,也是治疗难治性产后出血的一项重要措施。

Objective To discuss the application value of ligation of ascendant branch of uterine arteries in massive hemorrhage during cesarean section. Methods 16 patients with hemorrhage during cesarean section were divided into research group （n=10） and observation group （n=6）.In the control group,patients were first provided with regular hemostasis and then hysterectomy if it was invalid,while in the research group,if regular hemostasis didn＇t take effect, then the ligation of ascendant branch of uterine arteries was performed right away.The haemostatic effect,postoperative complication and recovery were observed in both groups. Results In the research group,9 patients were performed with bilateral ascending uterine arteries ligation and only 1 patient was with lateral ascending uterine arteries ligation.The intraoperative blood loss,number of blood transfusion,cases of hysterectomy and average hospital stay in the research group were all less than those in the control group （P〈0.05）.The rate of blood transfusion,incision infection rate and number of hysterectomy in the research group were 70.0%,10.0%, and 0 respectively.In the observation group,these were 83.3%,16.7%,and 1 in turn.There was no damage to adjacent organs. Conclusion The application of ascending uterine arteries ligation to stop bleeding during cesarean section is effective,fast,easy and without complication.Early application can avoid increasing the incidences of blood transfusion and infection,also keep uterus intact,which is a fast,effective and practical obstetric technology for hemorrhage during cesarean section when the regular treatment is ineffective.In addition,the ligation of ascendant branch of uterine arteries acts as an important measure to tackle in- tractable postpartum hemorrhage.