宫腔球囊压迫、子宫动脉结扎和B-Lynch缝合在剖宫产难治性产后出血的应用

Application value of uterine balloon compression,uterine artery ligation and B-Lynch suture in refractory postpartum hemorrhage after cesarean section

目的:探讨宫腔球囊压迫、子宫动脉结扎和B-Lynch缝合在剖宫产术难治性产后出血的临床应用。方法:选择剖宫产发生难治性产后出血的115例产妇作为研究对象,根据术中情况采用宫腔球囊压迫、子宫动脉结扎和B-Lynch缝合3种不同的手术方法治疗产后出血,当一种手术方法不能有效止血时术者根据经验选择两者之间的联合方式治疗产后出血,根据手术方式分为单一手术组和联合手术组(子宫动脉结扎+B-Lynch捆绑、子宫动脉结扎+球囊压迫、球囊压迫+B-Lynch捆绑);其中单一手术组又分为宫腔球囊压迫组、子宫动脉结扎组和B-Lynch捆绑组3个亚组。分析比较3种手术方式单用和联用的临床效果。结果:宫腔球囊压迫组止血成功率为92.31%,高于子宫动脉结扎组的止血成功率(63.49%)和B-Lynch缝合组止血成功率(61.54%),差异有统计学意义(P<0.05);宫腔球囊压迫组的手术时间少于子宫动脉结扎组和B-Lynch缝合组,差异有统计学意义(P<0.01);3组在术中出血量、24 h出血量、住院时间、24 h血红蛋白变化量等方面,差异无统计学意义(P>0.05)。单一手术组的手术时间、术中出血量、24 h总出血量、术后住院时间、输血率、合并弥散性血管内凝血、合并休克方面均少于联合手术组,差异有统计学意义(P<0.01)。而在24 h血红蛋白变化量、切除子宫、术后转ICU、产褥感染、恶露持续时间和子宫复旧方面2组之间差异无统计学意义(P>0.05)。结论:球囊压迫止血成功率高,手术时间短,可以考虑作为难治性产后出血的首选手术方案。当一种手术方案不能有效止血时,要及时采用联合手术方案,这并不增加产妇后期并发症的风险。

Objective:To investigate the clinical application value of uterine balloon compression,uterine artery ligation and B-Lynch suture in refractory postpartum hemorrhage after cesarean section.Methods:A total of 115 women with refractory postpartum hemorrhage after cesarean section were treated with three different surgical methods of uterine balloon compression,uterine artery ligation and B-Lynch suture.When one surgical method could not effectively stop bleeding,the operators chose the combined method to treat postpartum bleeding according to their experience.According to the surgical method,the patients were divided into the single surgery group(including uterine balloon compression group,uterine artery ligation group and B-Lynch suture group)and combined surgery group(including uterine artery ligation+B-Lynch suture group,uterine artery ligation+balloon compression group and balloon compression+B-Lynch suture group).The clinical effects between the single surgery group and combined surgery group were analyzed and compared.Results:The success rate of hemostasis of uterine balloon compression(92.31%)was greater than that of uterine artery ligation(63.49%)and B-Lynch suture(61.54%)(P<0.05).The operative time of uterine balloon compression was less than that of uterine artery ligation and B-Lynch suture(P<0.01).There was no statistical significance in the intraoperative hemorrhage,24-hour hemorrhage,length of stay,and 24-hour hemoglobin change among three single groups(P>0.05).The operation time,intraoperative bleeding,24-hour total bleeding,postoperative hospital stay,blood transfusion rate,combined diffuse intravasc ular coagulation and shock in three single surgery groups were lower than those in three combined surgery group(P<0.01).However,there was no statistical difference in the 24-hour hemoglobin change,hysterectomy,postoperative transfer to ICU,puerperal infection,lochia duration and uterine involution between two groups(P>0.05).Conclusions:Balloon compression hemostasis has high success rate and short operation time,so it can be considered as the first choice for refractory postpartum hemorrhage.When a surgical option is not effective in hemostasis,the combined surgical protocols should be timely used,which does not increase the risk of late maternal complications.