改良 B-lynch 缝合术与宫腔填塞治疗宫缩乏力性产后出血疗效比较

A comparative study for modified B-Lynch suture and uterine packing for the treatment of uterine atony postpartum hemorrhage

目的：比较改良B-lynch缝合术与宫腔填塞治疗宫缩乏力性产后出血的效果。方法82例剖宫产后宫缩乏力的产后出血患者按照数字表法随机分为两组，观察组41例，对照组41例，观察组采用改良B-lynch缝合术治疗，对照组采用宫腔填塞方法治疗。记录手术时间、出血量、输血量、子宫切除率、产褥病率等。结果观察组术后恶露无异常，无严重并发症及不良反应发生，切口均Ⅱ/甲级愈合，总有效率为100.0％。对照组有3例患者手术后效果不佳行子宫切除手术止血，总有效率为92．7％。两组差异有统计学意义（χ^2=4.720，P＜0．05）。观察组在手术时间、出血量、输血量、产褥病率和子宫切除率方面均少于对照组（t＝4．924、2．776、3．065，χ^2=5．690、4．780，P＜0．05，P＜0．01）。观察组在术后7 d子宫三径大于对照组（t＝2.169，P＜0.05），在30 d和42 d时两组子宫三径差异无统计学意义（t＝0．624、0．582，均P＞0．05）。结论改良B-lynch缝合术对于剖宫产宫缩乏力性产后出血的治疗效果明显优于宫腔填塞方法。

Objective To study the curative effects for modified B-Lynch suture and uterine packing for the treatment of uterine atony postpartum hemorrhage.Methods 82 patients with uterine atony postpartum hemorrhage were randomly divided into the two groups,the observation group（n=41） and the control group（n=41）.The patients in the observation group were operated through modified B-Lynch suture,while the patients in the control group were operated through uterine packing.For both groups,operative time,blood loss,blood transfusion,whether hysterectomy, puerperal morbidity,three diameter of the uterus were compared.Results Postoperative lochia without exception,no serious complications and adverse reactions occurred incision Ⅱ/A healed.The total effective rate was 100.0%. There were three cases of the control group after surgery which were ineffective hysterectomy surgery to stop bleeding, the total effective rate was 92.7%.There were significant differences between the two groups （χ^2=4.720, P 〈0.05）.In the observation group,operative time,blood loss,blood transfusion,puerperal morbidity and hysterectomy rates were less than those of the control group （t=4.924,2.776,3.065,χ^2=5.690,4.780,P〈0.05,P〈0.01）. The bservation group after 7d uterus three diameter were greater than that of the control group （t=2.169,P〈0.05）, in the 30d and 42d of the two groups,there were no significant differences in three diameter of the uterus （ t=0.624, 0.582,all P〉0.05）.Conclusion Treatment effect through modified B-Lynch suture for cesarean section uterine atony postpartum hemorrhage was significantly better than the uterine packing method.