子宫下段暂时性环扎在中央型前置胎盘术中出血处理的应用价值

Application value of temporary lower uterine segment cerclage in placenta previa intraoperative bleeding

目的探讨子宫下段暂时性环扎在中央型前置胎盘术中出血处理的应用效果及安全性。方法回顾性分析2011年6月至2015年6月绵阳市妇幼保健院收治的中央型前置胎盘患者90例的临床资料,根据止血方式将其分为观察组(54例)与对照组(36例),对照组产妇采取常规止血治疗,观察组产妇在剥离胎盘前及子宫局部处理或全切除前,迅速使用一次性硅胶尿管环扎子宫下段阻断子宫体血液供应,在子宫体血运阻断后进行常规止血操作,术后放开环扎尿管恢复子宫血供(排除子宫已切除患者),比较两组产妇治疗效果及临床结局。结果两组产妇干预前出血量比较差异无统计学意义(P>0.05);观察组产妇卡前列素氨丁三醇用量、术中总出血量、总输血量、子宫切除率明显低于对照组,差异有统计学意义(P<0.05);两组患者止血成功率均为100%;两组患者子宫坏死、切口感染、宫腔积血等并发症发生率比较,差异无统计学意义(P>0.05)。结论子宫下段暂时性环扎术治疗前置胎盘分娩术中出血患者,止血效果较好,能迅速降低术中出血量,有效减少患者药物应用及输血量,止血成功率较高,同时子宫坏死等并发症发生率较低,应用安全性较高。

Objective To study efficacy and safety of temporary lower uterine segment cerclage in placenta previa intraoperative hemorrhage.Methods 90 patients with central type of placenta previa hospitalized in Maternal and Child Health Care Hospital of Mianyang from June 2011 to June 2015 were chosen.According to hemostasis methods,they were divided into observation group（n=54） and control group（n =36）.In control group,only routine hemostatic were given to maternal.In observation group,before uterus partial or total excision,silica gel urine pipe were used rapidly to ring in lower uterine segment to block blood supply of uterine body,and then practiced routine hemostasis operation.At last released the cerclage urine tube to recover blood supply and compared maternal treatment effect and clinical outcome of the two groups.Results The amount of bleeding before intervention had no significant difference（P〉0.05）,tromethamine dosage,intraoperative blood loss,total blood transfusion amount and rate of hysterectomy of observation group were significantly lower than the control group（P〈0.05）,success hemostasis rate of the two groups were both100%.The incidence of complications such as uterus resection of uterine cavity hemorrhage necrosis,infection and hematometra had no significant difference（P〉0.05）.Conclusion Temporary lower uterine segment cerclage has good hemostatic effect in treating placenta previa intraoperative bleeding.It can quickly reduce the intraoperative blood loss,reduce patients＇ drug application and blood transfusion amount,improve hemostatic rate and with lower incidence of uterine necrosis.This operative technique has superior security.