子宫网压缝合术在剖宫产产后出血中的应用

Application of uterine netlike compression suture to postpartum hemorrhage

目的探讨一种新的缝合方式—子宫网压缝合术在剖宫产产后出血的应用效果,总结手术适应证及手术介入时机。方法回顾性分析10例难治性产后出血患者的临床资料,出血原因为剖宫产后宫缩乏力,均经常规处置无效后进行子宫网压缝合术,评价其止血效果及恢复情况,总结手术适应证及手术介入时机。结果所有患者行子宫网压缝合术后5~10 min子宫活动性出血停止;术后2 h累计阴道流血量均<20 ml,生命体征平稳,尿量正常,止血治疗有效。术后5 d进行垂体激素、甲状腺激素、肾上腺激素及女性激素检测均在正常范围;术后均无高热、腹部持续疼痛、子宫切口感染,腹部切口均为甲级愈合。术后42 d复查,所有患者恶露均已干净,超声检查示子宫复旧良好。结论子宫网压缝合术能有效控制子宫收缩乏力性产后出血。手术适应证为对经子宫按摩、促宫缩药物注射、子宫动脉结扎等措施处理仍无法止血的宫缩乏力性产后出血;手术介入时机为出血量达到1 500 ml以上。

Objective To explore the application efficacy of a new suture method-uterine netlike compression suture in postpartum hemorrhage during cesarean section, and to summarize the surgical indications and the timing for surgical intervention. Methods Clinical data of 10 patients with intractable postpartum hemorrhage were retrospectively analyzed. The cause for hemorrhage of all the patients was uterine inertia during cesarean section. Uterine netlike compression suture was conducted in all cases after conventional treatment failed. The hemostatic efficacy and recovery were evaluated, and the surgical indications and the timing of surgical intervention were summarized. Results For all 10 patients, active hemorrhage ceased after 5 - 10 minutes of uterine netlike compression suture, the cumulative amount of vaginal bleeding was less than 20 ml 2 hours after surgery, and the vital signs were stable and urine volumes were normal,which prompted an effective hemostatic treatment. Five days after surgery, the results of pituitary hormone, thyroid hormone, adrenal hormone and female hormone detection were normal. No postoperative fever, persistent abdominal pain, or uterine incision infection was observed, and the healing of abdominal incision was assessed as grade A. Forty-two days after surgery, the lochia exhausted, and the uterine involution was good in all 10 patients. Conclusion Uterine netlike compression suture can effectively control postpartum hemorrhage due to uterine inertia. The surgical indication is intractable postpartum hemorrhage due to uterine inertia when uterine massage, injection of uterine contraction agents, and uterine artery ligation failed. The timing of surgical intervention is bleeding loss of more than 1 500 ml.