宫腔水囊压迫止血、常规8字缝合联合子宫动脉结扎治疗凶险性前置胎盘的效果观察

Observation on effect of uterine cavity water sac compression hemostasis combined with conventional 8-shape suture and uterine artery ligation on pernicious placenta previa

目的探讨宫腔水囊压迫止血、常规8字缝合联合子宫动脉结扎治疗凶险性前置胎盘(PPP)的临床效果。方法抽取2015年1月至2020年10月晋城市人民医院诊治的65例PPP患者,根据患者止血方法分为A组(32例)和B组(33例)。A组给予宫腔水囊压迫止血+常规缝合+子宫动脉结扎,B组给予常规8字缝合+子宫动脉结扎。比较两组患者出血量、围术期指标、新生儿观察指标和并发症发生率,并观察两组手术前后卵巢功能变化。结果 A组术中、术后24 h出血量及阴道出血量均少于B组(P均<0.05)。A组手术时间短于B组,但差异未见统计学意义(P>0.05);A组住院时间短于B组,差异有统计学意义(P<0.05)。两组新生儿出生体质量、新生儿Apgar评分及血红蛋白水平比较差异未见统计学意义(P均>0.05)。术前,两组患者卵巢功能指标水平比较差异均未见统计学意义(P均>0.05);术后,两组雌二醇水平均降低,促卵泡激素、促黄体生成素水平均升高,但A组降低或升高幅度均小于B组(P均<0.05)。A组并发症发生率(9.38%,3/32)低于B组(30.30%,10/33),P<0.05。结论宫腔球囊压迫止血联合常规8字缝合、子宫动脉结扎应用于PPP患者,止血效果好,对卵巢功能损伤小,可减少失血性休克等并发症并促进患者术后恢复。

Objective To investigate the the clinical effect of uterine cavity water sac compression hemostasis combined with conventional 8-shape suture and uterine artery ligation on pernicious placenta previa(PPP).Methods Sixty-five patients with PPP who were diagnosed and treated in Jincheng People’s Hospital from January 2015 to October 2020 were selected.According to the hemostasis method,the patients were divided into group A(32 cases)and group B(33 cases).Group A was given uterine cavity water sac compression hemostasis combined with conventional suture and uterine artery ligation,while group B was given conventional 8-shape suture combined with uterine artery ligation hemostasis.The blood loss,perioperative indicators,neonatal observation indexes and incidence of complications were compared between the two groups.The preoperative and postoperative ovarian function of the two groups were observed.Results The intraoperative blood loss,24 hour-postoperative hemorrhage and vaginal blood loss of the group A were less than those of the group B(all P<0.05).The operation time of the group A was shorter than that of the group B,but the difference was not statistically significant(P>0.05).The length of hospital stay in the group A was shorter than that in the group B,and the difference was statistically significant(P<0.05).There was no significant difference in neonatal birth weight,neonatal Apgar score and the level of hemoglobin between the two groups(all P>0.05).Before operation,there was no significant difference in the levels of ovarian function indexes between the two groups(all P>0.05).After operation,the estradiol level decreased,and the levels of follicle stimulating hormone and luteinizing hormone increased in the two groups,however,the amplitudes of decrease and increase in the group A were smaller than those in the group B(all P<0.05).The total incidence of complications in the group A(9.38%,3/32)was lower than that in the group B(30.30%,10/33),P<0.05.Conclusions Uterine cavity water sac compression hemostasis combined with conventional 8-shape suture and uterine artery ligation,in the treatment of PPP,has good hemostatic effects and less damage to ovarian function.Moreover,it can lower risk of complications,for example,hemorrhagic shock,and faster postoperative recovery.