晨笛网压缝合术在难治性产后出血中的应用研究

Chendi Netlike Compression Suture and Its Initial Application in the Treatment of Intractable Postpartum Hemorrhage

目的探讨晨笛网压缝合术（Chen-Di Network Compression Suture CNCS）在难治性产后出血治疗中的应用价值。方法回顾分析晨笛网压缝合术（CNCS）对17例难治性产后出血患者的临床治疗,评价手术疗效及手术安全性。结果 17例行CNCS后,子宫活动性出血5～10min停止,观察10～30min阴道无明显流血,关腹,均成功保留患者子宫。术后5d垂体激素、甲状腺激素、肾上腺激素及女性激素各项数值均在正常范围;MRI：术后4d宫壁见散在点状信号,未见宫腔积液,术后46d宫壁肌层信号均匀,宫内膜线清晰;超声检查：术后42d子宫前后径3.5～4.5cm,宫壁肌层回声均匀,复旧形态良好;宫腔镜：术后3～5个月,宫腔无粘连,内膜形态正常,输卵管开口清晰。随访：17例患者术后42d复查,恶露均已净;7例仍在哺乳期,其余病例停止哺乳后1～2个月经恢复正常。结论 CNCS在难治性产后出血治疗中具有重要应用价值,具有止血快、无术后并发症的特点,在产后出血中对经子宫按压、促宫缩药物注射仍无法止血的乏力性产后出血患者,可选择CNCS进行急救。

Objective To investigate the application value of Chendi netlike compression suture（ CNCS） for treating intractable postpartum hemorrhage（ PPH）. Methods 17 cases of intractable postpartum hemorrhage by CNCS were retrospectively analyed,and the efficacy and security were evaluated and observed. Results The active bleeding stopped within 5 ～ 10 min after the CNCS was implemented in all 17 cases. No obviously virginal bleeding was observed in 30 min before abdomen closure. All uterus were reserved. Hormones levels： pituitary hormone,thyroid hormone,adrenal hormone and female sex hormone were normal on the fifth postoperative day. MRI： scattered punctiform signals in the uterine wall and no uterine cavity effusion on the fourth day; uniform signals of the muscle layer of the uterus and clear line of endometrium 46 days later. Ultrasonic inspection： the anteroposterior dimension of the uterus was 3. 5 ～ 4. 5cm,the echo of the muscle layer was even and the uterus reconversion was fine in 42 days. Hysteroscope inspection： no intrauterine adhesion,normal endometrium and clear openings of the fallopian tubes 5months later. Follow-up： 17 cases of patients 42 days after the review,lochia were clean; 7 cases were still breast-feeding,the remaining cases after stoping breastfeeding were normal menstruation. Conclusion The CNCS had much value in treating intractable PPH,which was recommended in obstetric emergency in case of uterus massage,medical treatment,intrauterine gauze tamponade,even uterine artery ligation and B-Lynch suture fail to arrest bleeding in atonic PPH.