宫颈上提缝合术治疗前置胎盘剖宫产术宫颈管出血的效果

The effect of cervical suture in the treatment of cervical canal hemorrhage during placenta previa cesarean section

目的比较局部缝合术与宫颈上提缝合术治疗前置胎盘剖宫产术宫颈管出血的临床效果及预后影响。方法选取秦皇岛市海港医院2012年10月至2017年10月收治的前置胎盘剖宫产术发生宫颈管出血的患者64例,依据宫颈缝合方式分为宫颈上提缝合组和局部缝合组,每组32例。比较两组患者的手术情况(包括手术时间、术中出血量、红细胞悬液输入量、血浆输入量、止血时间、术后1 d阴道流血量)、宫颈管出血原因及程度。术后随访8周,比较两组患者腹腔感染率、子宫切除率及产褥病率。结果宫颈上提缝合组患者手术时间[(74±15)min]、止血时间[(18±4)min]均明显短于局部缝合组[分别为(97±20)min、(33±7)min, P值均<0.05]。宫颈上提缝合组患者术中出血量[(769±88)ml]、红细胞悬液输入量[(429±28)ml]、血浆输入量[(112±21)ml]、术后1 d阴道流血量[(99±18)ml]均明显少于局部缝合组[分别为(925±104)、(538±44)、(190±44)、(169±23)ml,P值均<0.05]。宫颈上提缝合组与局部缝合组患者宫颈管出血原因及程度比较差异无统计学意义(P>0.05);术后8周宫颈上提缝合组腹腔感染率(3.12%)、子宫切除率(0.00%)均明显低于局部缝合组(分别为9.37%、12.50%,P值均<0.05),两组患者产褥病率比较差异无统计学意义(P>0.05),宫颈上提缝合组术后总不良反应发生率(9.37%)明显低于局部缝合组(31.25%,P<0.05)。结论宫颈上提缝合术治疗前置胎盘剖宫产术宫颈管出血对于患者术中情况有明显改善,安全性高,预后好,值得在临床推广。

Objective To compare the clinical effects and prognosis of local suture and cervical suture for cervical canal hemorrhage during placenta previa cesarean section. Methods Sixty-four patients with cervical canal hemorrhage who underwent placenta previa cesarean section from October 2012 to October 2017 in Qinhuangdao Seaport Hospital were selected and divided into cervical supine suture group(32 cases) and local suture group(32 cases) according to cervical suture method. The operation time, intraoperative blood loss, red blood cell suspension input, plasma input, hemostasis time, vaginal bleeding after one day of the two groups were compared, and the causes and extent of cervical canal bleeding were also compared. After 8 weeks of follow-up, the intra-abdominal infection rate, hysterectomy rate and puerperal morbidity rate were compared between the two groups. Results The operation time and hemostasis time in the cervical suture group [(74±15) min,(18±4) min, respectively] were significantly shorter than those in the local suture group [(97±20)min,(33±7)min, respectively, P<0.05]. The intraoperative blood loss, red blood cell suspension input, plasma input, and vaginal bleeding one day after operation in the cervical suture group[(769±88),(429±28),(112±21),(99±18)ml, respectively] were significantly less than those in the local suture group[(925±104),(538±44),(190±44),(169±23)ml, respectively, all P<0.05]. There was no significant difference in the cause or extent of cervical canal bleeding between the two groups(P>0.05). Eight weeks after operation, the incidence of abdominal infection and hysterectomy in the cervical suture group(3.12%, 0.00%, respectively) were significantly lower than those in the local suture group(9.37%, 12.50%, respectively, P<0.05), but there was no significant difference in the incidence of sputum between the two groups(P>0.05). The total incidence of postoperative adverse reactions in the cervical suture group(9.37%)was significantly lower than that in the local suture group(31.25%, P<0.05). Conclusion Cervical suture for cervical canal hemorrhage during placenta previa cesarean section can significantly improve the patient’s intraoperative situation with high safety and good prognosis, which is worthy of clinical promotion.