晨笛网压缝合术治疗难治性产后出血

Clinical Analysis on Chen-di Network Compression Suture for Intractable Postpartum Hemorrhage:45 Cases Report

目的探讨晨笛网压缝合术(Chen-Di network compression suture,CNCS)治疗难治性产后出血的临床应用价值。方法收集2012年1月～2016年12月在成都市第五人民医院接受CNCS缝合术治疗的45例难治性产后出血患者的临床资料,按CNCS临床应用阶段分为3组:Ⅰ组8例,均为拟行子宫切除术的患者,行子宫CNCS缝合术;Ⅱ组12例,为常规方法止血无效,出血量≥2 500 ml的患者,行子宫CNCS缝合术+子宫动脉结扎术;Ⅲ组25例,为常规方法止血过程中出血量≥1 500 ml的患者,直接行子宫CNCS缝合术。回顾性分析三组患者的手术结果及随访资料。结果 45例患者经CNCS缝合术均成功保留子宫,手术成功率100%(45/45)。(1)Ⅰ组:4例B-Lynch缝合止血无效,4例常规方法止血无效且评估不具备B-Lynch缝合可行性患者,行CNCS缝合术,术毕8例子宫活动性出血5～10 min停止,8例术后均转入ICU,平均出血量(4 200±381. 73) ml。(2)Ⅱ组:12例前期常规方法止血无效,出血量≥2 500 ml的患者,4例行CNCS缝合+双侧子宫动脉上行支结扎,6例行CNCS缝合+双侧子宫动脉(上行支、下行支)结扎,2例行CNCS缝合+双侧子宫动脉下行支结扎,术毕12例子宫活动性出血5～8 min停止,8例术后转入ICU,平均出血量(2 808±231. 55) ml。(3)Ⅲ组:25例常规处理过程中出血量≥1 500 ml的患者,直接行CNCS缝合术,3例合并前置胎盘患者加行双侧子宫动脉下行支结扎,术毕25例子宫活动性出血5～8 min出血停止,5例术后转入ICU,平均出血量(1 780±160. 12) ml。(4)随访:45例随访3～52个月,随访率100%(45/45)。患者术后42 d复查恶露均排净,腹壁切口甲级愈合;术后46 d MRI及超声复查示子宫宫壁肌层均匀,宫内膜线清晰,复旧良好。40例患者停止哺乳1～2个月月经恢复正常(5例仍在哺乳中); 3例术后再次妊娠行人工流产术,1例术后29个月再次经剖宫产诞下一健康女婴。结论 CNCS缝合术治疗PPH安全有效,可以作为治疗难治性PPH的一种选择术式; CNCS缝合术对难治性PPH患者子宫保留具有积极意义; CNCS缝合术对医疗器械及材料无特殊要求,尤其适合医疗条件有限的基层医院开展应用。

Objective To investigate the clinical value of Chen-di network compression suture(CNCS)for treating intractable postpartum hemorrhage(PPH). Methods A total of 45 PPH cases treated by CNCS from January 2012 to December 2016 in our hospital were divided into 3 groups according to the clinical stage of application.GroupⅠ:8 cases of routinely unavoidable hysterectomy were treated with CNCS;GroupⅡ:12 cases of failed hemostasis by common methods with blood loss more than 2 500 ml were treated with CNCS and uterine artery ligation;GroupⅢ:25 cases of blood loss more than 1 500ml under routine methods of hemostasis were treated with CNCS.The related clinical data of the 45 cases were retrospectively analyzed. Results The uterus reserved in all 45 cases with a successful rate of 100%(45/45).①GroupⅠof 8 cases were performed the CNCS including 4 of invalid B-Lynch suture and 4 of failed routine method of hemostasis without the feasibility of B-Lynch suture.After the CNCS were adopted,the bleeding ceased in 5 to 10 minutes.All 8 cases were cared in ICU after the operation.The average blood loss was 4 200±381.73 ml.②GroupⅡof 12 cases were carried out the CNCS,with an additional ligation of bilateral uterine artery ascending branch in 4 cases,descending branch in 2 cases and both branches in 6 cases.The bleeding ceased in 5 to 8 minutes after the operation.Only 8 women were sent to ICU.The average blood loss was 2 808±231.55ml.③Group 3 of 25 cases with blood loss more than 1 500 ml were treated with the CNCS,including 3 cases combined with bilateral descending uterine artery ligation for placenta praevia,and achieved hemostasis in 5 to 8 minutes.Only 5 women were sent to ICU.The average blood loss was 1 780±160.12 ml.④All cases were followed up for 3 to 52 months with the follow-up rate of 100%.All cases had finished lochia in 42 days.MRI and ultrasonographic exam evidenced adqulis muscular layer of uterine wall,clear endometrium line and normal volume uterine in 46 days.Forty women resumed normal menstruation in one or two months after ceasing the breast-feeding,while 5 women were still in lactation.Three women gestated again and chose induced abortion.One woman gave birth to a second healthy girl infant successfully. Conclusions The CNCS is a safe and effective treatment for PPH,which would be a choice for refractory PPH in consideration.It has a positive significance for uterine reservation.It requires no special medical equipments and materials,especially suiting for the majority of primary hospitals with limited medical conditions.