子宫排钉式缝合术用于剖宫产术中宫缩乏力性产后出血的治疗体会

The Treatment Experience of Peg-suture to Postpartum Hemorrhage Caused by Uterine Inertia in Cesarean Section

目的:探讨子宫排钉式缝合术用于剖宫产术中宫缩乏力性产后出血的临床价值。方法:2007年1月—2014年5月在我院住院分娩发生产后出血218例,回顾性分析其中因剖宫产术中子宫收缩乏力性产后出血的82例经按摩子宫及应用缩宫素、欣母沛等保守治疗无效患者的临床资料。其中40例实施子宫排钉式缝合术(观察组),20例实施B-Lynch缝合术(对照1组),22例实施宫腔纱条填塞术(对照2组)。全子宫收缩乏力患者联合子宫动脉、卵巢动脉结扎。比较3组患者止血效果,术后子宫切口愈合及子宫血运情况,以及术后并发症、子宫复旧情况、恶露排净时间和月经复潮时间。结果:观察组止血率100%,对照1组止血率85.00%,对照2组止血率81.8%,3组间比较差异有统计学意义(P<0.05)。3组产妇子宫切口均愈合良好,子宫血流恢复良好,卵巢血流丰富。观察组产妇6例发热;对照1组3例发热,1例肠梗阻;对照2组6例发热,2例误将纱条与子宫切口缝合。3组产妇发热的发生率差异无统计学意义(P>0.05)。3组产妇子宫复旧佳、恶露排净时间、月经复潮时间差异均无统计学意义(P>0.05)。结论:子宫排钉式缝合术治疗剖宫产术中子宫收缩乏力性产后出血,止血迅速,成功率高,并发症少,易于掌握,值得推广。

Objective：To investigate the clinical value of peg-suture to postpartum hemorrhage caused by uterine inertia.Methods：There are 218 cases of postpartum hemorrhage during Jan. 2007 to May. 2014, 82 cases of them received conservative treatment（uterine massotherapy, oxytocin, hemabate and so on）, there is no effect. Observing group include 40 cases received peg-suture, control group 1 include 20 cases received B-Lynch suture, control group 2 include 22 cases received gauze pocking of uterine. The patients with complete uterine inertia were performed ovarian artery ligation and uterine artery ligation. To compare the effect of hemostasis, healing of uterine incision, blood flow of uterine, complication, uterine involution, ejection of lochia and reappearance of menstruation. Results：The hemostasis rate in each of the 3 groups are 100%, 85.00% and 81.8%,the differences are significant（P〈0.05）. In the three groups, healing of uterine incision, blood flow of uterine and ovary are well.In the observing group, 6 cases run fever, in control group 1, 3 cases run fever, 1 case get intestinal obstruction, in control group2, 6 cases run fever, 2 cases the gauze are sutured with incision of uterine, the differences are not significant（ P〈0.05）. In the three groups, the difference of uterine involution, ejection of lochin and reappearance of menstruation are not significant（ P〈0.05）.Conclusions：To postpartum hemorrhage caused by uterine inertia, peg-suture has high rate of success, good hemostasis effect and low complication, operation time is short, manipulation is simple, so is worth spreading.