子宫下段连续折叠缝合术在疤痕子宫孕妇剖宫产中的效果及安全性分析

Analysis of the Effect and Safety of continuous foldable Suturing of the lower Segment of the Uterus in cesarean Section of pregnant women with Scar Uterus

目的探究子宫下段连续折叠缝合术在疤痕子宫孕妇剖宫产中的临床价值及安全性。方法回顾性选取河南郑州美中商都妇产医院2019年2月至2020年12月收治的78例疤痕子宫孕妇,均行剖宫产术,根据治疗方案不同进行分组,将接受常规缝合及缩宫素静脉滴注治疗的38例作为对照组,观察组40例于对照组基础接受子宫下段连续纵向折叠缝合术。比较两组止血效果、手术时间、产后出血量、住院时间、术前及术后1 d凝血因子水平[血管紧张素Ⅱ(AngⅡ)、血小板、凝血因子Ⅷ、凝血因子Ⅸ]、输血量、并发症发生率。结果观察组止血有效率(100.00%)高于对照组(84.21%),差异有统计学意义(P<0.05)。两组手术时间比较,差异无统计学意义(P>0.05);观察组产后出血量、输血量均少于对照组,差异有统计学意义(P<0.05)。观察组住院时间短于对照组,差异有统计学意义(P<0.05)。术后1 d,两组凝血因子水平均发生改变,且观察组AngⅡ、血小板、凝血因子Ⅷ、凝血因子Ⅸ高于对照组,差异有统计学意义(P<0.05)。观察组腹腔粘连、子宫下段收缩差发生率均低于对照组(P<0.05)。结论子宫下段连续折叠缝合术能改善疤痕子宫孕妇凝血功能,可增强止血效果,减少出血量及输血量,促进患者术后恢复,且并发症少。

Objective To explore the clinical value and safety of continuous foldable suturing of the lower segment of the uterus in cesarean section of pregnant women with scar uterus.Methods A retrospective study was conducted on 78 pregnant women with scarred uterus who were admitted to Henan Zhengzhou US-China Commercial Capital Maternity Hospital in Henan from February 2019 to December 2020.All women underwent cesarean section and were divided into groups according to different treatment plans.38 women who received conventional suturing and intravenous infusion of oxytocin were selected as the control group,while 40 women in the observation group received continuous longitudinal folding suturing of the lower segment of the uterus on the basis of the control group.The hemostatic effect,surgical time,postpartum bleeding volume,hospital stay,preoperative and postoperative coagulation factor levels[angiotensin Ⅱ(AngⅡ),platelets,coagulation factor Ⅷ coagulation factor Ⅸ],blood transfusion volume,and incidence of complications between the two groups were compared.Results The effective rate of hemostasis in the observation group(100.00%)was higher than that in the control group(84.21%),with a statistically significant difference(P<0.05).There was no statistically significant difference in surgical time between the two groups(P>0.05);The amount of postpartum bleeding and blood transfusion in the observation group was lower than that in the control group,with a statistically significant difference(P<0.05).The hospitalization time of the observation group was shorter than that of the control group,and the difference was statistically significant(P<0.05).On the first day after surgery,the levels of coagulation factors in both groups changed,and the levels of Ang Ⅱ,platelets,coagulation factor Ⅷ,and coagulation factorⅨin the observation group were higher than those in the control group,with statistical significance(P<0.05).The incidence of abdominal adhesions and lower uterine segment contractions in the observation group was lower than that in the control group(P<0.05).Conclusion Continuous folding and suturing of the lower segment of the uterus can improve the coagulation function of pregnant women with scar uterus,enhance the hemostatic effect,reduce bleeding and transfusion volume,promote postoperative recovery of patients,and have fewer complications.