保守性手术控制剖宫产术严重产后出血的效果

Efficacy of Conservative Surgeries on Controlling Severe Postpartum Hemorrhage Following Cesarean Section

目的:探讨改良子宫捆扎术与宫腔填纱术控制剖宫产术严重产后出血的临床效果,并分析失败原因。方法:将135例剖宫产术严重产后出血患者按数字表法随机分为改良子宫捆扎术组(捆扎组,65例)和宫腔填纱术组(填纱组,70例),比较2组手术操作时间、术中及术后出血量、止血成功率、子宫切除率和并发症发生率。结果:捆扎组的手术时间、术中出血量明显少于填纱组(P<0.05);2组术后出血量、止血成功率、子宫切除率比较差异无统计学意义(均P>0.05);捆扎组胎盘因素中前置胎盘和胎盘植入出血者的止血成功率低于填纱组(P<0.05),子宫过度伸展因素出血者的止血成功率高于填纱组(P<0.05);2组产妇术后恶露持续时间、月经复潮时间及经量减少、痛经及宫腔粘连和产褥期感染的发生率比较差异无统计学意义(均P>0.05)。结论:改良子宫捆扎术术中出血量少,操作时间短,对子宫过度伸展性因素出血的止血效果更佳;而宫腔填纱术适用于胎盘因素出血者,临床处理应个体化。

Objective：To investigate the efficacy of different hemostatic surgeries to control severe postpartum hemorrhage following cesarean section and analyze the reason for homeostasis failure. Methods：135 cases with severe postpartum hemorrhage following cesarean section were randomly divided into improved uterine compression sutures group （65 cases） and uterine gauze packing group （70 cases）. The operating time,intraoperative and postoperative bleeding,hemostatic success rate,hysterectomy rate and complication rate were compared between two groups. Results：The operating time and intraoperative bleeding of improved uterine compression sutures group were significantly lower than those of uterine gauze packing group （P〈0.05）. There were not significant differences in hemostatic success rate ,postoperative bleeding and hysterectomy rate between the two groups （all P〉0.05）. The hemostatic success rate of patients with placental disorders including placenta previa, placenta accrete in improved uterine compression sutures group was significantly lower than that in uterine gauze packing group （P〈0.05）,while the hemostatic success rate of patients with excessive uterine stretch factor was significantly higher than that in uterine gauze packing group （P〈0.05）. There were no significant difference in the incidence of lochia time after surgery, time of menstruation turn over and menstruation reduction, dysmenorrheal, intrauterine adhesion and obstetric infection between the two groups （all P〉0.05）. Conclusions：Improved uterine compression sutures had such advantages as less bleeding ,shorter operating time and higher success rate in excessive uterine stretch factor inducing bleeding. The uterine gauze packing has better hemostatic effect for placental factors inducing hemorrhage. Clinical treatment should be individualized.