B-Lynch与晨笛网压缝合术治疗难治性产后出血术中情况及围手术期结局的比较研究

Comparative Study on the Intraoperative Situation and Perioperative Outcomes of B-Lynch Suture and Chendi Net-Like Compression Suture in the Treatment of Refractory Postpartum Hemorrhage

目的对比研究B-Lynch与晨笛网压缝合术(CNCS)治疗难治性产后出血术中情况及围手术期结局。方法采用回顾性队列分析,选取2017年8月至2023年9月因难治性产后出血行子宫压迫缝合术产妇86例,根据术式不同分为B-Lynch缝合组(43例)及CNCS缝合组(43例)。比较两组术中出血、术后2 h出血、术后输血、术后住院时间、不良预后等围手术期结局。结果两组产妇年龄、孕产次、孕周、术前诊断差异均无统计学意义(P>0.05),两组术中并发症诊断,差异无统计学意义(P>0.05);辅助手术:子宫动脉结扎、卵巢子宫血管吻合支结扎、髂内动脉结扎B-Lynch组均高于CNCS组,差异有统计学意义(P<0.05);术中出血量、术后2 h出血量B-Lynch组高于CNCS组,差异有统计学意义(P<0.01);术后输血例数、住院天数B-Lynch组高于CNCS组,差异均有统计学意义(P<0.01);子宫切除、宫腔积液、宫腔感染3项不良预后,B-Lynch组均高于CNCS组,差异有统计学意义(P<0.01)。结论CNCS缝合术术中及术后出血量、辅助盆腔血管结扎处于较低水平,较B-Lynch缝合术术中具有更高止血效率;CNCS缝合术保持宫腔排空状态,有效降低了因宫腔引流不畅发生感染的风险,具有更优治疗结局。

Objective To compare the intraoperative situation and perioperative outcomes of B-Lynch suture and Chendi net-like compression suture(CNCS)in the treatment of refractory postpartum hemorrhage.Methods A retrospective cohort study was conducted using clinical data of 86 women who underwent uterine compression suture for refractory postpartum hemorrhage from August 2017 to September 2023.The women were divided into B-Lynch suture group(43 cases)and CNCS suture group(43 cases)according to different surgical procedures.The intraoperative bleeding,postoperative 2-hour bleeding,postoperative blood transfusion,postoperative hospitalization time,and adverse prognosis were compared.Results There was no significant difference in the age,parity,gestational weeks,preoperative diagnosis and intraoperative complications(P>0.05).The rates of auxiliary operations,including uterine artery ligation,ovarian-uterine vascular anastomosis branch ligation and vascular anastomotic branch ligation,in the B-Lynch group were higher than those in the CNCS group,with statistically significant differences(P<0.05).There were more intraoperative bleeding and postoperative 2-hour bleeding in the B-Lynch group,as compared to the CNCS group(P<0.01).The rate of postoperative blood transfusion and the days of hospitalization in the B-Lynch group were higher and longer than those in the CNCS group(P<0.01).The rates of uterine resection,uterine cavity effusion and uterine cavity infection in the B-Lynch group were higher than those in the CNCS group,with statistically significant differences(P<0.01).Conclusion CNCS suture is more efficient as showed by less intraoperative and postoperative bleeding and lower rate of pelvic vascular ligation,which maintains the emptying status of the uterine cavity,effectively reduces the risk of infection due to poor drainage,and thus has better therapeutic outcomes.