双侧子宫动脉上行支结扎在中央性前置胎盘剖宫产术中大出血的应用研究

Application of bilateral ascending uterine artery ligation in the treatment of massive hemorrhage in cesarean section of placenta praevia centralis

目的研究双侧子宫动脉上行支结扎应用在中央性前置胎盘剖宫产术中大出血的效果。方法选取重庆市妇幼保健院2015年3月至2016年3月中央性前置胎盘剖宫产术中出现大出血情况的产妇120例,根据手术中采用的不同处置方式分为研究组63例和对照组57例。对照组术中采取常规手段止血,出血情况无法阻止时对髂内动脉进行结扎或切除子宫;研究组术中采取常规方法止血并对双侧子宫动脉上行支进行结扎。比较两组术中出血及输血情况、手术时间、术后恢复情况。结果研究组术中出血量[(362.42±94.12)mL]显著低于对照组[(604.67±124.38)mL](P<0.05);研究组术后24 h出血量[(442.43±124.52)mL]显著低于对照组[(734.56±218.34)mL](P<0.05);研究组输血量[(182.45±26.53)mL]显著低于对照组[(337.56±34.78)mL](P<0.05);研究组的手术时间显著短于对照组(P<0.05);两组产后长期恢复情况比较差异无统计学意义(P>0.05)。结论在中央性前置胎盘剖宫产术中出现大出血情况下对双侧子宫动脉上行支进行结扎来止血,能够缩短手术时间,减少产妇失血,减少输血量。

Objective To study the effect of bilateral ascending uterine artery ligation in placenta praevia centralis cesarean section with massive hemorrhage. Methods 120 maternal with placenta praevia centralis hemorrhage who underwent cesarean section from March 2011 to March 2016 in Chongqing Maternal and Child Health - Care Hospital were divided into two groups according to different treatment used in the operation： study group （63 cases） and the control group （57 cases）. The control group took conventional means of surgery to stop bleeding, and if the bleeding could not be stopped the internal iliac artery ligation or removal of the uterus was performed;the study group also adopted conventional methods to stop bleeding, and if the bleeding could not be stopped the bilateral ascending uterine artery branches were ligated. The amount of blood loss and blood transfusion, time of operation and short - term and long- term recovery were compared between the two groups. Results The amount of blood loss in the study group [ （362. 42 ± 94. 12） mL] was significantly lower than that in the control group[ （604. 67 ± 124. 38） roll （P 〈0. 05）. The 24h post operation bleeding volume in the study group [ （442.43 ± 124. 52 ） mL] was signifieantly lower than that of the control group[ （734. 56 ±218.34） mL ] （P 〈 0.05 ）. The blood transfusion of the study group [ （ 182.45 ± 26. 53 ） mL ] was significantly lower than that of the control group[ （337. 56 ± 34. 78） mL] （P 〈 0. 05 ） ; The operation time of the study group was significantly shorter than that of the control group（ P 〈 0.05 ）. There was no significant difference between the study group and the control group in long -term post -natal recovery（P 〉 0. 05）. Conclusion Ligation of the ascending branch of bilateral uterine artery to stop bleeding in cesarean section of placenta praevia centralis can reduce time of operation, maternal blood loss and amount of blood transfusion.