子宫B-lynch缝合术与子宫动脉上行支结扎术治疗产后出血效果比较

Comparison of uterine B-Lynch suture and ascending branch of uterine artery ligation for treating women with postpartum hemorrhage

目的:探讨子宫背带式缝合术(子宫B-lynch缝合术)和子宫动脉上行支结扎术治疗产后出血(PPH)效果。方法:回顾性分析2016年10月-2020年10月在本院妇产科剖宫产PPH临床资料,根据止血术式不同分为缝合组46例和结扎组46例,分别给予子宫B-Lynch缝合术或子宫动脉上行支结扎术,对比两组止血疗效、围手术期指标(术中出血量、术后24h出血量、输血量、手术时间及住院时间)、术后预后情况(产褥病、恶露未尽、切口感染、宫腔粘连、子宫复旧等并发症)及术前及术后1周的卵巢功能指标[抗苗勒管激素(AMH)、雌二酮(E_(2))、促黄体生成素(LH)、促卵泡刺激素(FSH)]。结果:缝合组止血总有效率(95.7%)与结扎组(93.5%)无差异,两组术中出血量(1554.6±281.7 ml、1568.6±287.2 ml)、术后24h出血量(225.6±55.6 ml、236.2±61.1 ml)、输血量(1215.3±129.2 ml、1239.6±118.7ml)、手术时间(58.6±9.1min、60.8±9.2min)及住院时间(7.3±2.1d、8.1±2.3d)无差异,两组产褥病(13.0%、15.2%)、恶露未尽(6.5%、4.0%)、切口感染(2.2%、4.4%)、宫腔粘连(0、4.4%)、子宫复旧(82.6%、87.0%)发生率无差异(均P>0.05);术后1周,两组血清AMH、E_(2)水平均较术前升高,LH、FSH较术前降低(均P<0.05),但两组间无差异(P>0.05)。结论:治疗PPH子宫B-Lynch缝合术与子宫动脉上行支结扎术止血效果相当,均未增加并发症,术后卵巢功能恢复良好。

Objective:To explore the effect of uterine strap suture(uterine B-lynch suture)or uterine artery ascending branch ligation for treating women with postpartum hemorrhage(PPH).Methods:The clinical data of 92 women with PPH from October 2016 to October 2020 were analyzed retrospectively.These women were divided into group A(46 women with uterine B-lynch suture)and group B(46 women with uterine artery ascending branch ligation).The hemostatic efficacy,the perioperative indicators,such as the intraoperative blood loss,the blood loss in 24h after surgery,the blood transfusion volume,the surgical time,and the hospital stay time,the postoperative prognosis status,such as puerperalism,incomplete elimination of lochia,incision infection,intrauterine adhesions,adverse uterine involution,and other complications,and the ovarian function indexes,such as anti-Müllerian hormone(AMH),estrogen(E_(2)),luteinizing hormone(LH),and follicle stimulating hormone(FSH)before surgery and in 1 week after surgery,of the women were compared between the two groups.Results:There were no significant differences in the total effective rate of hemostasis(95.7%vs.93.5%),the intraoperative blood loss(1554.6±281.7 ml vs.1568.6±287.2 ml),the blood loss in postoperative 24h(225.6±55.6 ml vs.236.2±61.1 ml),the blood transfusion volume(1215.3±129.2ml vs.1239.6±118.7ml),the operation time(58.6±9.1min vs.60.8±9.2min),the hospital stay time(7.3±2.1d vs.8.1±2.3d),the incidence of puerperal disease(13.0%vs.15.2%),the rate of incomplete elimination of lochia(6.5%vs.4.0%),the rate of incision infection(2.2%vs.4.4%),the rate of intrauterine adhesion(0 vs.4.4%),and the rate of adverse uterine involution(82.6%vs.87.0%)of the women between the two groups(all P>0.05).The serum AMH and E2 levels of the women in the two groups in 1 week after surgery had increased compared with those before surgery operation,while the LH and FSH levels of the women in the two groups had decreased(all P<0.05),but which of the women had no significant difference between the two groups(P>0.05).Conclusion:Uterine B-Lynch suture for treating the women with PPH can achieve the same hemostatic effect as that of uterine artery ascending branch ligation.Both uterine B-Lynch suture and uterine artery ascending branch ligation will not increase the complications,and has good postoperative ovarian function recovery.