剖宫产术中子宫收缩乏力性出血的手术止血方法及预后研究

Study on surgical hemostasis and prognosis of postpartum hemorrhage due to uterine atony during cesarean section

目的：探讨B-Lynch缝合术及双侧子宫动脉上行支结扎术处理剖宫产术中子宫收缩乏力性出血的止血效果及对产妇预后的影响。方法：选取2011年1月～2011年12月南方医科大学附属深圳市妇幼保健院剖宫产术中子宫收缩乏力性出血经保守治疗无效的患者64例,其中采用B-Lynch缝合止血35例、子宫动脉结扎止血29例,分析并比较两组的出血量、手术时间及止血的有效率;并于产后1年测定患者血清性激素水平,产后6-12个月行阴道彩超检查子宫动脉供血情况,评价手术对卵巢功能及子宫血液循环的影响。结果：B-Lynch缝合组及子宫动脉结扎组治疗有效率分别为97.1%和96.6%;与子宫动脉结扎组比较,B-Lynch缝合组出血量少、手术时间短、止血有效率高,但两组差异无统计学意义（P〉0.05）;两组血清卵泡刺激素（FSH）、黄体生成素（LH）及雌二醇水平比较,差异无统计学意义（P〉0.05）;两组左、右子宫动脉阻抗指数（RI）及收缩期峰值与舒张末期血流速度（S/D）比较,差异均无统计学意义（P〉0.05）。结论：B-Lynch缝合术及双侧子宫动脉上行支结扎术应用于剖宫产术中子宫收缩乏力性出血均有操作简单迅速、止血效果确切等优点,对患者术后子宫血液循环及卵巢功能无明显影响,值得临床推广。

Objective： To explore the effects of B - Lynch suture and bilateral ascending uterine artery ligation for postpartum hem- orrhage due to uterine atoMy during cesarean section and their impacts on puerperal women. Methods： Sixty - four patients with postpartum hemorrhage due to uterine atoMy during cesarean section who failed in conservative treatment in the hospital from January 2011 to December 2011 were selected, including 35 patients treated with B -Lynch suture and 29 patients treated with ascending uterine artery ligation; the a- mounts of hemorrhage, operation times and effective rates in the two groups were analyzed and compared ; serum sex hormones levels were de- tected after one year; transvaginal color Doppler ultrasonography was performed to examine blood supply of uterine artery at 6 - 12 months after delivery ; the effect of surgery on ovarian function and uterine blood circulation was evaluated. Results： The effective rates in B - Lynch suture group and ascending uterine artery ligation group were 97. 1% and 96. 6%, respectively; compared with ascending uterine artery liga- tion group, the amount of hemorrhage in B - Lynch suture group was less, the operation time was shorter, the effective rate was higher, but there was no statistically significant difference （P 〉 0.05） ; there was no statistically significant difference in serum levels of follicle - stimu- lating hormone （FSH）, luteinizing hormone （LH） and estradiol, resistance indexes and S/D of left and right uterine arteries between the two groups （ P 〉 0. 05 ） . Conclusion ： B - Lynch suture and ascending uterine artery ligation used for postpartum hemorrhage due to uterine atomy during cesarean section have the advantages of simplicity, rapidness and high effectiveness, which have no significant impact on uterine blood circulation and ovarian function, and these methods are worthy of clinical popularization.