B—Lynch缝合术处理宫缩乏力产后出血的疗效及对远期生育力的影响

B-Lynch suture in the treatment of postpartum hemorrhage due to uterine atony and impact on long-term fertility

目的评价B—Lynch缝合术对宫缩乏力导致产后出血的疗效，明确该术式对远期生育力和再次妊娠结局的影响。方法收集2006年1月1日至2013年12月31日在北京大学第一医院行剖宫产、因宫缩乏力导致的术中出血行B—Lynch缝合术的150例患者的病历资料。对产妇进行随访，记录术后月经情况和术后再妊娠结局。对数据资料采用描述性统计分析。结果150例患者均成功保留了子宫。仅行BLynch缝合术止血满意者131例（87．3％），B～Lynch缝合术同时行双侧子宫动脉上行支结扎术止血满意者18例（12．0％），1例（0．7％）B—Lynch缝合术后宫缩仍不佳，行子宫动脉栓塞术，止血满意。共随访到患者141例（94．0％），其中104例随访到术后月经情况。月经周期及经量较前无变化者67例（64．4％），月经延长者5例（4．8％），月经量增多者10例（9．6％），月经量减少者22例（21．2％）。141例患者中，术后成功妊娠并分娩者11例（23．9％），分娩时间为术后2-4年，分娩方式均为足月择期剖宫产分娩。结论B—Lynch缝合术处理宫缩乏力导致的产后出血简单、安全，疗效肯定，对远期月经的改变不明显。尚未发现B—Lynch缝合术与不孕的关系。B—Lynch缝合术后再次妊娠者结局良好。

Objective To evaluate the effects of B-Lynch suture for postpartum hemorrhage due to uterine atony, and to clarify its influence on long-term fertility and next pregnancy outcome. Methods We retrospectively collected the medical records of 150 women who underwent B-Lynch suture during cesarean section due to intra-operative bleeding caused by uterine atony from January 1, 2006 to December 31, 2013 in Peking University First Hospital. Follow-up was carried out to assess postoperative menstruation and subsequent pregnancy outcomes. Results All the cases underwent B-Lynch suture which successfully retained the uterus. Satisfactory hemostasis was achieved in 131 women （87.3%） who underwent B-Lynch suture only, and in eighteen women （12.0%） who had bilateral uterine artery ascending branch ligation at the same time; and in one patient （0.7%） who underwent B-Lynch suture and uterine artery embolization four hours later due to poor uterine contraction. Of the 141 （94.0%） cases followed up after surgery, menstrual cycle was assessed in a total of 104 women： no changes in the menstrual cycle and bleeding volume were noted in 67 cases （64.4%）, prolonged menstruation was observed in five cases （4.8%）, menorrhagia in ten cases （9.6%）, and hypomenorrhea in 22 cases （21.2%）. Eleven women （23.9%） became pregnant and delivered in two to four years after the surgery, and all were full-term abdominal delivery. Conclusions B-Lynch suture is a simple, safe, and effective treatment for postpartum hemorrhage due to uterine atony, without significant change of menstruation. B-Lynch suture is not associated with infertility, and the postoperative pregnant outcome is good.