前置胎盘伴胎盘植入剖宫产术中行子宫下段横行环状压迫缝合止血的效果

Effect of the transverse annular compression suture hemostasis in lower uterine with placenta previa complicated with placenta accreta during caesarean section

目的:探讨子宫下段横行环状压迫缝合止血在前置胎盘伴胎盘植入剖宫产术中的应用效果。方法:选择前置胎盘伴胎盘植入产妇72例,均行剖宫产手术。随机分为A组42例和B组30例,A组行子宫下段横行环状外压迫缝合止血联合子宫下段修补术止血,B组行传统"8"字缝合与宫腔球囊压迫法止血,比较2组药物用量、止血效果、凝血功能变化、产后并发症、子宫复旧与产妇心理状态。结果:A组卡前列素氨丁三醇用量低于B组(P<0.05),干预前、干预时、干预后出血量及总出血量均低于B组(P<0.05),A组输血率及输血量均显著低于B组(P<0.05);A组无子宫切除,与B组的43.33%比较差异有统计学意义(P<0.05);A组子宫复旧率为100.00%,显著高于B组的56.67%(P<0.05);A组产后Zung焦虑自评量表及抑郁自评量表评分均低于B组(P<0.05)。结论:在前置胎盘伴胎盘植入剖宫产术中应用子宫下段横行环状压迫缝合止血具有良好的止血效果,相比于子宫内压迫止血法能够更好地缩短手术时间、降低术中出血量及子宫切除率,改善产妇产后心理状态与凝血功能,具有一定的临床应用价值。

Objective： To explore the effects of transverse annular compression suture（ TACS） hemostasis in lower uterine with placenta previa complicated with placenta accreta during cesarean section. Methods： Seventy-two puerperas with placenta previa complicated with placenta accreta were treated with cesarean section from January 2013 to January 2015,and randomly divided into the group A（ 42 cases） and group B（ 30 cases）. The group A and group B were treated with TACS combined with repair hemostasis and traditional ＂8-type＂suture combined wih balloon compression hemostasis,respectively. The drug usage,hemostasis effect,coagulation,postpartum complications,uterine involution and maternal mental between two groups were compared. Results： The Hemabate usage in group A was significantly lower than that in group B（ P〈0. 05）,the blooding before intervention,intervention and after intervention,and total blood loss in group A were significantly lower than those in group B（ P〈0. 05） and the transfusion rate and blood transfusion in group A were significantly lower than those in group B（ P〈0. 05）. The difference of hysterectomy rate between group A（ 0. 00%） and group B（ 43. 33%） was statistically significant（ P〈0. 05）. The uterine involution rate in group A（ 100. 00%） was significantly higher than that in group B（ 56. 67 %）（ P〈0. 05）. The postpartum Self-rating Anxiety Scale and Self-rating Depression Scale scores in group A were significantly lower than those in group B（ P〈0. 05）. Conclusions： Compared with the compression hemostasis in womb,the effect of transverse annular compression suture hemostasis in lower uterine with placenta previa complicated with placenta accreta during cesarean section is good,which can effectively shorten the operation time,reduce the intraoperative blooding and hysterectomy rate,improve postpartum mental state and coagulation function,and has certain clinical value.