B-Lynch缝合联合宫腔纱条填塞在中央型前置胎盘合并粘连性胎盘植入剖宫产术中出血的应用价值

The application value of B-Lynch sutures combined with uterine cavity gauze packing in the bleeding of central placenta previa combined with abnormally adherent placenta during cesarean section

目的分析比较B-Lynch缝合联合宫腔纱条填塞与B-Lynch缝合联合宫腔球囊填塞治疗中央型前置胎盘合并粘连性胎盘植入剖宫产术中止血的效果。方法回顾性分析2021年7月至2023年10月南方医科大学南方医院收治的中央型前置胎盘合并粘连性胎盘植入的48例患者,其中B-Lynch缝合联合宫腔纱条填塞23例(研究组),B-Lynch缝合联合宫腔球囊填塞25例(对照组),对比两组术中出血量、产后24 h出血量、术后介入手术率、术后ICU转入率及住院费用等指标。结果两组术中出血量差异无统计学意义(P>0.05)。与对照组相比,研究组产后24 h出血量、输注红细胞量、手术时间、住院费用均减少;术后住院时间更短(P<0.05)。对照组有3例患者接受了子宫动脉栓塞介入手术,1例患者转入ICU。两组ICU转入率及术后介入手术率均差异无统计学意义(P>0.05)。两组新生儿Apgar评分均无差异。出院后对患者随访至产后42 d,结果显示所有患者均无晚期产后出血,无子宫切口愈合不良,无膀胱输尿管损伤及肠梗阻等并发症发生。结论B-Lynch缝合联合宫腔纱条填塞是一种简单易行、安全可靠的复合止血方法,适于广大基层医疗机构推广应用。

Objective To analyze the pregnancy outcomes of combined B-Lynch suture and intrauterine packing with gauze versus combined B-Lynch suture and intrauterine balloon tamponade in the treatment of central placenta previa with abnormally adherent placenta.Methods A retrospective analysis was conducted on 48 patients with central type placenta previa combined with adhesive placental implantation at Nanfang Hospital of Southern Medical University from July 2021 to October 2023.Among them,23 patients were treated with B-Lynch suture combined with uterine gauze tamponade(study group),and 25 patients were treated with B-Lynch suture combined with uterine balloon tamponade(control group).The intraoperative bleeding volume,postpartum 24-hour bleeding volume,postoperative intervention surgery rate,postoperative ICU transfer rate,and hospitalization costs were compared between the two groups.Results There was no statistically significant difference in intraoperative bleeding between the two groups(P>0.05).Compared with the control group,the study group showed a decrease in 24-hour postpartum hemorrhage,red blood cell infusion,surgical time,and hospitalization costs;The postoperative hospitalization days are shorter(P<0.05).Three patients in the control group underwent uterine artery embolization intervention surgery,and one patient was transferred to the ICU.There was no statistically significant difference in the ICU transfer rate and postoperative intervention surgery rate between the two groups(P>0.05).There was no difference in Apgar scores between the two groups of newborns.After discharge,patients were followed up until 42 days postpartum,and the results showed that all patients had no late postpartum hemorrhage,no poor healing of uterine incisions,no complications such as bladder ureteral injury and intestinal obstruction.Conclusion Combined B-Lynch suture and intrauterine gauze packing is a simple,feasible,safe,and reliable hemostatic method.It is suitable for primary healthcare institutions and worthy of promotion.