Subsequent pregnancy outcomes and fertility rates in the case series that underwent bilateral hypogastric artery ligation(BHGAL)due to severe postpartum hemorrhage

Objective:To evaluate the effect of bilateral hypogastric artery ligation(BHGAL)on women's pregnancy outcomes and fertility rates in cases with severe postpartum hemorrhage.Methods:Patients hospitalized in a tertiary care center between 2007 and 2018 were included in the study.The records of cases were obtained from the hospital database,retrospectively.Maternal demographic data,morbidities or complications associated with BHGAL surgery,any additional haemostatic interventional or surgical procedures,preoperative admission and lowest postoperative haematocrit-hemoglobin values,blood products given,type of anaesthesia,intensive care unit(ICU)and length of hospital stay were recorded.In cases without surgical sterilization,future fertility and subsequent pregnancy outcomes were assessed for at least two years after operation.Information was obtained through face-to-face or telephone interviews with patients whose long-term fertility and subsequent pregnancy outcomes were assessed.Results:Sixty-eight patients with BHGAL surgery history were included in the study.26 Of 37 cases(70%)that did not undergo surgical sterilization had a desire for pregnancy after the surgery.Six of these cases(23%)were diagnosed with secondary infertility.The fertility rate of these cases was 77%,and subsequent pregnancy was detected in 20 women.A total of 25 pregnancies,including first and second pregnancies,developed,and 15 of these pregnancies resulted in term delivery,six preterm births,one stillbirth,and three abortions.Conclusions:The postoperative pregnancy rate was found to be higher than the rate of women with infertility problems,and this surgery does not seem to adversely affect pregnancy outcomes.This is a tertiary center experience and cohort studies with large patient series are needed.

Emergency rescue of a patient with hemorrhagic shock caused by superior mesenteric artery rupture:A case report

BACKGROUND Superior mesenteric artery(SMA)injuries rarely occur during blunt abdominal injuries,with an incidence of<1%.The clinical manifestations mainly include abdominal hemorrhage and peritoneal irritation,which progress rapidly and are easily misdiagnosed.Quick and accurate diagnosis and timely effective treatment are greatly significant in managing emergent cases.This report describes emergency rescue by a multidisciplinary team of a patient with hemorrhagic shock caused by SMA rupture.CASE SUMMARY A 55-year-old man with hemorrhagic shock presented with SMA rupture.On admission,he showed extremely unstable vital signs and was unconscious with a laceration on his head,heart rate of 143 beats/min,shallow and fast breathing(frequency>35 beats/min),and blood pressure as low as 20/10 mmHg(1 mmHg=0.133 kPa).Computed tomography revealed abdominal and pelvic hematocele effusion,suggesting active bleeding.The patient was suspected of partial rupture of the distal SMA branch.The patient underwent emergency mesenteric artery ligation,scalp suture,and liver laceration closure.In view of conditions with acute onset,rapid progression,and high bleeding volume,key points of nursing were conducted,including activating emergency protocol,opening of the green channel,and arranging relevant examinations with various medical staff for quick diagnosis.The seamless collaboration of the multidisciplinary team helped shorten the preoperative preparation time.Emergency laparotomy exploration and mesenteric artery ligation were performed to mitigate hemorrhagic shock while establishing efficient venous accesses and closely monitoring the patient’s condition to ensure hemodynamic stability.Strict measures were taken to avoid intraoperative hypothermia and infection.CONCLUSION After 3.5 h of emergency rescue and medical care,bleeding was successfully controlled,and the patient’s condition was stabilized.Subsequently,the patient was transferred to the intensive care unit for continuous monitoring and treatment.On the sixth day,the patient was weaned off the ventilator,extubated,and relocated to a specialized ward.Through diligent medical intervention and attentive nursing,the patient made a full recovery and was discharged on day 22.The follow-up visit confirmed the patient’s successful recovery.

Dissection and ligation of the lateral circumflex femoral artery is not necessary when using the direct anterior approach for total hip arthroplasty

BACKGROUND Branches of the lateral circumflex femoral artery(LCFA) stretch across the surgical field during a direct anterior total hip arthroplasty. It is an anatomical marker in direct anterior approach. As an important vessel around the hip joint,this vessel was ligated in most situations. Although ligation of the vascular pedicle of the LCFA is a common, traditional procedure used to decrease bleeding, the ligation of the pedicle of the vessel is tedious and time-consuming.AIM To explore whether this ligation is truly necessary in a direct anterior approach to total hip arthroplasty.METHODS This single-center, single-surgeon, prospective study was performed to compare patients' bleeding undergoing ligation of the branches of the LCFA pedicle(group A) vs those treated with electrocautery from the branches of the LCFA(group B). In both groups, the pedicles were identified in the intermuscular plane between the tensor fasciae lata and the rectus femoris muscles. In group A, the pedicles were ligated with a silk ligature. In group B, the branches coming off the LCFA were controlled with electrocautery. We compared preoperative vs postoperative changes in blood hemoglobin levels, intraoperative blood loss,operative time, rates of transfusion, re-bleeding, and hematoma between the two groups.RESULTS The reduction of hemoglobin in group A was 20.9 ± 7.0, and in group B it was 21.2 ± 4.9. There was no statistically significant difference between the two groups(P > 0.05). The actual calculated blood loss in group A was 784 ± 125 mL,and in group B it was 722 ± 153 mL. There was a trend in group A having more blood loss(P = 0.078). The estimated blood loss in group A was 344 ± 88 mL, and in group B it was 346 ± 73 mL. There was no statistically significant difference between the two groups(P = 0.883). In addition, there were no significant differences in the rates of postoperative transfusion(10% vs 6.7%, P > 0.05),postoperative hematomas(6.7% vs 13.3%, P > 0.05), or re-bleeding(13.3% vs 20%,P > 0.05) between the two groups.CONCLUSION Ligation of the pedicle of the LCFA has no advantage in preventing or decreasing bleeding during or after a total hip arthroplasty using the direct anterior approach. Ligation of the pedicle of the vessel is a cumbersome, unnecessary procedure and can be replaced by electrocautery control of the branches off this artery that course through the surgical field.

A Study of Myocardial Ischemia Model Induced by Left Coronary Artery Ligation in Rats

Objective: Coronary artery was ligated to study the characteristics of myocardial ischemia in rats. Methods: The left anterior descending artery was ligated to establish the rat model of acute myocardial ischemia. All animals were divided into normal control group, sham operation group and model group. 1, 2 and 4 weeks after modeling, ECG (II lead) was recorded, the weight of whole heart and left ventricle were recorded and organ indexes were calculated;myocardial infarct size was determined by TTC;CK, CK-MB, LDH, AST contents of serum were detected;cardiac function was determined by left ventricular intubation via carotid artery and left ventricular was taken to perform pathological observation. Results: 1 week after modeling, compared with the sham operation group, the ECG and heart function index of rats model had significant change, but the myocardial enzymes did not change significantly;4 weeks after modeling, the ECG and cardiac function of animal models had a recovery trend, but the myocardial enzymes, including CK, CK-MB, LDH, AST, were significantly increased;1 week after modeling, the left ventricular indexes of model rats were increased;the infarct size was about 30%, myocardial cell necrosis and granulation tissue hyperplasia could be observed in infarction area;with the modeling time extended, from 2 to 4 weeks, the left ventricular and heart indexes of model group were significantly increased;the infarct size was relatively constant, left ventricular became thickly, and fibrous or granulation tissue was significantly proliferated in infarction area under microscope. Conclusion: The indexes of myocardial ischemia induced by coronary artery ligation in rats are different at different time points. The results suggest that the time point should be selected to observe the anti-myocardial ischemia effect of the subjects from different aspects.

Early Ligation of the Inferior Pancreaticoduodenal Artery Using Intraoperative Ultrasonography during Pancreaticoduodenectomy

Background: While the safety of pancreaticoduodenectomy (PD) has improved, the high level of difficulty associated with this operation means that the procedure carries a high mortality rate compared to other gastrointestinal operations. Various trials have been implemented in efforts to reduce the incidence of complications after PD. In particular, a large amount of intraoperative bleeding and the use of red blood cell transfusions are reportedly risk factors for postoperative complications after PD. Aim: In an attempt to reduce the amount of intraoperative bleeding during PD, consideration was given to the anatomical characteristics of the region of the pancreatic head, and the gastroduodenal artery (GDA) and inferior pancreaticoduodenal artery (IPDA) were ligated in advance of separating the head from the portal vein. We herein report the use of ultrasonography during PD to facilitate the early identification and ligation of the IPDA. Case Presentation: A 72-year-old female was diagnosed with pancreatic cancer and underwent pylorus-preserving pancreatoduodenectomy. We used ultrasonography during the operation to initially identify the IPDA and then ligate it in advance, after which the GDA was ligated before separating the pancreatic head from the superior mesenteric artery and portal vein. Identification of the IPDA was performed with the SMA as a guide using ultrasonography in Doppler mode. The amount of intraoperative bleeding was 235 ml. The patient left the hospital without any postoperative complications and has since demonstrated a good postoperative course, with no evidence of recurrent disease. Conclusions: Early ligation of the IPDA using intraoperative US is non-invasive and makes it simple to identify the IPDA. This method may be a useful technique for reducing intraoperative bleeding during the normal course of PD procedures.

Role of Anterior Division of Internal Iliac Artery Ligation in Refractory Postpartum Haemorrhage—A Tertiary Care Hospital Based Study

Objective: Postpartum haemorrhage (PPH) is one of the important obstetrical emergencies and a leading cause of maternal morbidity and mortality. According to the World Health Organization, postpartum haemorrhage constitutes 25% of all maternal deaths worldwide. In situations where medical line of management fails to control postpartum haemorrhage, anterior division of internal iliac artery ligation can play an important role as a lifesaving and fertility preserving surgical procedure. Keeping this in mind, our study aimed to analyze indications and efficacy of anterior division of Internal Iliac artery ligation in the form of uterine salvage and saving maternal life. Study design: This was a retrospective study carried out in the Department of Obstetrics and Gynaecology, Government Medical College, Aurangabad during the period of July 2014-January 2016. A total of 57 cases that had undergone ligation of anterior division of internal iliac artery were included in the study and different indications and efficacy were studied. Results: Atonic PPH (52.63%) leads the list of indications for ligation anterior division of internal iliac artery ligation followed by traumatic (19.29%), adherent placenta (12.2%), mixed variety (10.52%) and coagulopathy (5.26). Maximum efficacy in terms of preserving fertility and saving maternal life was 73.33% and 93.3% respectively in atonic PPH. Overall efficacy of this procedure in terms of uterine salvage was 54.38% and in terms of saving maternal life was 87.71%. Conclusion: Anterior division of IIAL was effective method in controlling refractory PPH, reducing morbidity and preserving uterus and future fertility. It is safe life saving procedure at experienced hands.

Laparoscopic ligation of proximal splenic artery aneurysm with splenic function preservation

Splenic artery aneurysm is one of the most common visceral aneurysms,and patients with this type of aneurysm often present without symptoms.However,when rupture occurs,it can be a catastrophic event.Although most of these aneurysms can be treated with percutaneous embolization,some located in uncommon parts of the splenic artery may make this approach impossible.We present a patient with an aneurysm in the proximal splenic artery,close to the celiac trunk,which was treated by laparoscopic ligation only,without resection of the aneurysm,and with long-term preservation of splenic function.

Alteration of Levels of Cyclic Nucleotide and Analysis of SDS-PAGE in Autologous Transplanted Spleen and Splenic Artery Ligation

Intracellular levels of cyclic nucleotide were detected and mitogen stimulation assays were performed in young Sprague-Daewley rats and suspension of spleen tissue were separated by SDS-PAGE. Results indicated that intracellular levels of cyclic AMP in transplanted cell were significantly lower compared to the control group(P<0.01), the levels of cyclic GMP in transplant cell and the levels of cyclic nucleotide in splenic artery ligation groups were normal. Immunologic tests showed that the stimulation index by Con A for T cells was drastically decreased in the autotransplant and a normal proliferation of B cells after LPS stimulation in transplants. Electrophoresis showed differences in the protein patterns between both tissues. Mitogen stimulation and the protein patterns were not different between the control and splenic artery ligation groups. There were differences between the normal tissues and the transplants at the functional level, Suggesting simple autotransplant can not prevent overwhelming postsplenectomy infection. The intact cellular function after splenic artery ligation indicated that its anti-infection ability is superior to that of splenic transplants.

PERIPANCREATIC ARTERIAL LIGATION COMBINED WITH ARTERIAL INFUSION REGIONAL CHEMOTHERAPY FOR TREATING PATIENTS WITH ADVANCED PANCREATIC CARCINOMA

Objective To find out a new treatment method for advanced pancreatic carcinoma. Methods Twenty nine patients with advanced pancreatic carcinoma and liver metastases were randomly divided into 2 groups.Group A ( n =11) underwent bilio enterostomy and/or gastro enterostomy combined with systemic chemotherapy after operation;Group B( n =18) underwent bilio enterostomy and/or gastro enterostomy combined with peripancreatic arterial ligation and arterial infusion regional chemotherapy.The alleviation of clinical symptom,the change of carcinoma volume by BUS and CT scan,survival period and serum CEA were observed in two groups. Results The symptoms were alleviated apparently in most cases in Group B;BUS and CT scan showed that the tumor volume decreased apparently in Group B;The response rate was 67.7% in Group B,and 18.2% in Group A,respectively( P <0.01);the mean survival period was (4.8±0.6) months in Group A,and (12.5±1.2) months in Group B,respectively( P <0.01),there was significant difference between the two groups.The decrease of serum CEA was 54% in Group A and 60% in Group B,but the difference was not significant( P >0.05). Conclusion Peripancreatic arterial ligation combined with arterial infusion regional chmotherapy is believed to be effective against both pancreatic carcinoma and liver metastases,and it can alleviate the clinical symptoms,postpone the growth speed of tumor,and prolong the survival period.

Analysis of Endoscopic Sphenopalatine Artery Surgery for Refractory Epistaxis

Background: This study aimed to determine the safety and efficacy of sphenopalatine artery (SPA) surgery in patients with refractory epistaxis and to identify factors associated with the indications for surgery to assist clinicians in making prompt and appropriate decisions regarding SPA surgery for refractory epistaxis. Methods: We analyzed 97 consecutive patients with nasal bleeding hospitalized in our institution between April 2009 and March 2018. Clinicopathological characteristics and clinical outcomes were analyzed from retrospective chart reviews. Results: Of the 97 patients, 28 (29 sides) required SPA surgery. There were no differences in sex, anti-coagulant drug or antiplatelet use, hemoglobin concentration, or platelet count between Group A (patients who required surgery) and Group B (patients who did not require surgery). Age (58 vs. 67 years, p = 0.038) and severity of comorbidity (0 vs. 1, p = 0.039) were significantly lower in the surgery group. Patients who were younger and had lower Charlson Comorbidity Index (CCI) scores had more requirements for surgery than those who were older and had higher CCI scores. There was no significant difference between the groups with respect to the proportion of patients receiving blood transfusions;however, the length of hospitalization was significantly longer in Group A than in Group B (8.9 vs. 8 days, p = 0.038). Success rate (non-rebleeding rate) was 89%, comparable to that reported in previous studies. Conclusions: Endoscopic SPA surgery was found safe and effective method with few complications. Younger patients with lower CCI scores were found appropriate for SPA surgery for refractory epistaxis due in part to a lower risk of anesthesia.

Low ligation has a lower anastomotic leakage rate after rectal cancer surgery

BACKGROUND For laparoscopic rectal cancer surgery,the inferior mesenteric artery(IMA)can be ligated at its origin from the aorta[high ligation(HL)]or distally to the origin of the left colic artery[low ligation(LL)].Whether different ligation levels are related to different postoperative complications,operation time,and lymph node yield remains controversial.Therefore,we designed this study to determine the effects of different ligation levels in rectal cancer surgery.AIM To investigate the operative results following HL and LL of the IMA in rectal cancer patients.METHODS From January 2017 to July 2019,this retrospective cohort study collected information from 462 consecutive rectal cancer patients.According to the ligation level,235 patients were assigned to the HL group while 227 patients were assigned to the LL group.Data regarding the clinical characteristics,surgical characteristics and complications,pathological outcomes and postoperative recovery were obtained and compared between the two groups.A multivariate logistic regression analysis was performed to evaluate the possible risk factors for anastomotic leakage(AL).RESULTS Compared to the HL group,the LL group had a significantly lower AL rate,with 6(2.8%)cases in the LL group and 24(11.0%)cases in the HL group(P=0.001).The HL group also had a higher diverting stoma rate(16.5%vs 7.5%,P=0.003).A multivariate logistic regression analysis was subsequently performed to adjust for the confounding factors and confirmed that HL(OR=3.599;95%CI:1.374-9.425;P=0.009),tumor located below the peritoneal reflection(OR=2.751;95%CI:0.772-3.985;P=0.031)and age(≥65 years)(OR=2.494;95%CI:1.080-5.760;P=0.032)were risk factors for AL.There were no differences in terms of patient demographics,pathological outcomes,lymph nodes harvested,blood loss,hospital stay and urinary function(P>0.05).CONCLUSION In rectal cancer surgery,LL should be the preferred method,as it has a lower AL and diverting stoma rate.

Dealing with hepatic artery traumas:A clinical literature review

BACKGROUND The hepatic artery(HA)is one of the most threatened vascular structures during hepatopancreatobiliary(HPB)surgeries and interventional procedures.It can be affected by many clinical pictures,especially tumors,due to its anatomical position and neighborhood.AIM To reveal the evolution and recent developments in the management of HA traumas in the light of the literature.METHODS In this article,100 years of MEDLINE(PubMed)literature and articles including cases and series of HA injuries were reviewed,and the types of injury occurrence,treatment,and related complications and their management were compiled.RESULTS The risk of HA injury increases during cholecystectomies and pancreatoduodenectomies,among the most common operations.HA anatomy shows anomalies in approximately 15%-25%of the cases,further increasing this risk.The incidence of HA injury is not precisely known.Approaches that have evolved in recent years in managing patients with HA injury(laceration,transection,ligation,resection)with severe morbidity and mortality risk are reviewed in light of the current literature.CONCLUSION In conclusion,complications and deaths due to HA injury are less common today.The risk of complications increases in patients with hemodynamic instability,jaundice,cholangitis,and sepsis.Revealing the variations in the preoperative radiological evaluation will reduce the risks.In cases where HA injury is detected,arterial flow continuity should be tried to maintain with primary anastomosis,arterial transpositions,or grafts.In cases where bile duct injury develops,patients should be directed to HPB surgery centers,considering the possibility of accompanying HA injury.Large-scale and multicentric studies are needed to understand better the early and long-term results of HA ligation and determine preventive procedures.

Improved methodology for efficient establishment of the myocardial ischemia-reperfusion model in pigs through the median thoracic incision

To investigate the feasibility and effectiveness of establishing porcine ischemia-reperfusion models by ligating the left anterior descending(LAD)coronary artery,we first randomly divided 16 male Bama pigs into a sham group and a model group.After anesthesia,we separated the arteries and veins.Subsequently,we rapidly located the LAD coronary artery at the beginning of its first diagonal branch through a mid-chest incision.Then,we loosened and released the ligation line after five minutes of pre-occlusion.Finally,we ligated the LAD coronary artery in situ two minutes later and loosened the ligature 60 min after ischemia.Compared with the sham group,electrocardiogram showed multiple continuous lead ST-segment elevations,and ultrasound cardiogram showed significantly lower ejection fraction and left ventricular fractional shortening at one hour and seven days post-operation in the model group.Twenty-four hours after the operation,cardiac troponin T and creatine kinase-MB isoenzyme levels significantly increased in the model group,compared with the sham group.Hematoxylin and eosin staining showed the presence of many inflammatory cells infiltrating the interstitium of the myocardium in the model group but not in the sham group.Masson staining revealed a significant increase in infarct size in the ischemia/reperfusion group.All eight pigs in the model group recovered with normal sinus heart rates,and the survival rate was 100%.In conclusion,the method can provide an accurate and stable large animal model for preclinical research on ischemia/reperfusion with a high success rate and homogeneity of the myocardial infarction area.

Clinical significance of aberrant left hepatic artery during gastrectomy:A systematic review

BACKGROUND Vascular variations are frequently encountered during surgery.Approximately thirty percent of these variations are aberrant left hepatic arteries originating from the left gastric artery.AIM To summarize the safety and feasibility of aberrant left hepatic arteries(ALHA)ligation in gastric cancer patients who underwent laparoscopic-assisted gastrectomy(LAG).METHODS The literature search was systematically performed on databases including Pub Med,Embase,and Cochrane Library.The publishing date of eligible studies was from inception to June 2021.RESULTS A total of nine studies were included according to the inclusion and exclusion criteria in this review.The variation rate of ALHA ranged from 7.00%to 20.70%,and four studies compared the differences between the ALHA ligation group and the preservation group.Only one study showed worse postoperative outcomes in the ALHA ligation group.In all the included studies,a significant difference was found between the ALHA ligation group and the preservation group in terms of postoperative liver enzymes after LAG.However,there was no significant difference in the number of retrieved lymph nodes between the two groups.CONCLUSION In conclusion,it is not always safe and feasible for surgeons to ligate the ALHA during LAG surgery,and it is necessary for gastric cancer patients to undergo preoperative examination to clarify the ALHA subtypes,measure the diameter of the ALHA,and determine whether the patients have chronic liver disease.

Dual transformation therapy for giant hepatocellular carcinoma: Two case reports and review of literature

BACKGROUND In the translational therapy of giant hepatocellular carcinoma(HCC),hepatic arterial infusion chemotherapy(HAIC)combined with anti-PD-1 immunotherapy and tyrosine kinase inhibitors(TKI)after laparoscopic portal vein ligation(PVL)is extremely rare.This is a dual conversion therapy that combines surgery and oncology.Here,we report two cases of successful surgical completion after dual conversion therapy.CASE SUMMARY We report that a 54-year-old man and a 69-year-old woman were diagnosed with primary HCC combined with hepatitis B cirrhosis(case 2 also combined with fatty liver)on physical examination.Due to the insufficient residual liver volume assessed before surgery,laparoscopic right PVL was performed,followed by HAIC combined with anti-PD-1 immunotherapy and TKI.Finally,surgical resection was successfully completed,and pathology confirmed that the tumor was mostly necrotic(90%)in one case,and no live tumor tissue was found in the other case.CONCLUSION In the process of surgical transformation,our treatment plan takes into account the control and transformation of oncology at the same time,which is expected to provide more opportunities for radical hepatectomy and improve the prognosis of patients with large liver cancer.

子宫血管缝扎术及宫颈环状缝扎术联合双侧髂内动脉球囊阻断治疗PPP合并胎盘植入效果

目的:探讨凶险性前置胎盘(PPP)合并胎盘植入治疗效果。方法:选取2019年3月-2023年5月本院就诊治疗的PPP合并胎盘植入患者56例临床资料,根据治疗方式不同分为两组,采用子宫血管缝扎术及宫颈环状缝扎术联合双侧髂内动脉球囊阻断治疗为观察组26例,采用单纯双侧髂内动脉球囊阻断治疗为对照组30例,分析两组相关指标。结果:治疗后两组甲胎蛋白及绒毛膜促性腺激素水平均较术前降低,且观察组(82.6±26.3 ng/ml、122.3±56.3 mIU/ml)低于对照组(113.0±41.1 ng/ml、649.5±86.5 mIU/ml),总并发症发生率观察组(3.8%)低于对照组(23.3%)(均P<0.05);两组新生儿Apgar评分(9.6±0.3分、9.3±0.6分)无差异(P>0.05)。观察组住院时间(6.6±1.2d)及住院费用(3.2±0.6)万元均低于对照组(7.9±1.5d)(4.3±1.0)万元(P<0.05)结论:采取子宫血管缝扎与宫颈环状缝扎术、双侧髂内动脉球囊阻断治疗PPP合并胎盘植入可效果更佳,且可降低术后并发症,术后恢复更快,对新生儿未产生不良影响。

植入型凶险型前置胎盘计划性剖宫产术中子宫动脉结扎阻塞及宫腔填充术的有效性和安全性

目的探究植入型凶险型前置胎盘计划性剖宫产术中采用子宫动脉结扎阻塞及宫腔填充术的有效性和安全性。方法选取2019年12月至2021年12月唐山市妇幼保健院收治的132例植入型凶险型前置胎盘计划性剖宫产术治疗患者为研究对象,按不同的血管阻断方式分为子宫动脉栓塞术联合宫腔填充治疗组(对照组)和子宫动脉结扎联合宫腔填充治疗组(观察组),观察比较两组患者的手术时间、术中出血量、术中输血量、膀胱损伤率,并观察记录两组母婴结局情况,包括新生儿1min Apgar评分、子宫切除率、凝血功能异常发生率。记录患者术后不良反应的发生情况,包括发热、慢性盆腔疼痛、伤口愈合不良、术后血栓形成、月经量降低等。结果观察组患者的手术时间、膀胱损伤率均较对照组更低(t=4.428和5.621,P<0.05),术中出血量、术中输血量未见显著差异(t=1.472和1.729,P>0.05),两组新生儿出生1min Apgar评分未见显著差异(t=0.257,P>0.05),但观察组产妇的子宫切除率、凝血功能异常发生率显著低于对照组(t=3.722和4.628,P<0.05),两组患者均未发生严重的产科并发症,其中观察组患者发热、慢性盆腔疼痛、术后血栓形成、伤口愈合不良、术后月经量降低的发生率均显著低于对照组,差异具有统计学意义(t=6.274、4.726、3.872、3.872和4.218,P<0.05)。结论子宫动脉结扎术和子宫动脉造影栓塞术对植入型凶险型前置胎盘患者具有一定的临床疗效,其中子宫动脉结扎手术时间短,术后并发症发生率低,具有较好的有效性和安全性。

极早产儿支气管肺发育不良相关肺高压合并动脉导管未闭9例预后分析

目的分析9例支气管肺发育不良(bronchopulmonary dysplasia,BPD)相关肺高压(pulmonary hypertension,PH)合并动脉导管未闭(patent ductus arteriosus,PDA)极早产儿行PDA结扎术后的临床转归。方法回顾性分析9例合并PDA的BPD相关PH的极早产儿临床资料,所有患儿均给予PDA结扎手术,术后规律随访。结果手术治疗后7例患儿肺动脉压力降至正常,顺利脱机并出院,且后期规律门诊随访,均随访至2022年6月。随访者中最大者已4岁,所有患儿心脏超声示心脏结构及功能、肺动脉压力均正常,生长发育正常,无反复呼吸道感染发生。2例患儿死亡。结论合并PDA的BPD相关PH的极早产儿病情危重,在药物治疗失败的情况下,PDA适时结扎是改善预后的手段。

子宫动脉结扎联合腹主动脉球囊阻断术在胎盘植入性疾病剖宫产术中的应用

目的 :探讨子宫动脉结扎联合腹主动脉球囊阻断术在胎盘植入性疾病(placenta accreta spectrum disorders,PAS)剖宫产术中的有效性和有安全性。方法 :将83例PAS剖宫产产妇随机分为观察组(n=42)和对照组(n=41)。对照组给予腹主动脉球囊阻断剖宫产术,观察组给予子宫动脉结扎联合腹主动脉球囊阻断剖宫产术。比较2组手术相关指标和并发症。结果 :观察组手术时间长于对照组,术中出血量、术后24 h总出血量少于对照组,术后血红蛋白差值小于对照组(均P <0.05),并发症发生率低于对照组(4.76%vs 19.51%,χ^(2)=4.260,P=0.028)。结论 :子宫动脉结扎联合腹主动脉球囊阻断术有助于降低PAS剖宫产产妇术中及术后出血量,减少产后出血等并发症的发生。

子宫动脉栓塞术对产后出血患者并发症及再次妊娠围生期妊娠结局的影响

目的探讨子宫动脉栓塞术(UAE)对产后出血(PPH)患者并发症及再次妊娠围生期妊娠结局的影响。方法选择2015年1月至2019年12月唐山市妇幼保健院妇接收的79例UAE治疗的PPH患者作为UAE组,选择同期在我院接受子宫动脉结扎术(UAL)治疗的78例PPH患者作为UAL组。比较两组术中及术后恢复情况、卵巢功能指标水平、术后近远期并发症发生率及再次妊娠围生期妊娠结局。通过logistic回归分析确定产后出血治疗后远期并发症发生的影响因素。结果UAE组术中失血量[(959.70±203.15)mL]、止血时间[(30.59±5.81)min]、住院时间[(7.33±1.58)d]、产后月经恢复时间[(72.14±16.42)d]均少于UAL组,产后首次月经量/妊娠前平均月经量(1.13±0.35)多于UAL组,差异均有统计学意义(P<0.05);UAL组术后抗缪勒氏管激素(AMH)、雌二醇(E_(2))水平较术前降低(P<0.05),卵泡刺激素(FSH)水平较术前增高(P<0.05),两组术前后AMH、E_(2)、FSH的差值比较,差异有统计学意义(P<0.05);UAE组近期、远期并发症发生率分别为3.80%和5.06%,均低于UAL组(P<0.05);logistic回归分析显示,治疗方式是产后出血治疗后远期并发症发生的影响因素;两组再次妊娠者瘢痕部位妊娠、自然流产、前置胎盘等围产期妊娠结局发生率比较,差异无统计学意义(P>0.05)。结论与UAL相比,UAE对PPH患者的止血更迅速,月经恢复时间更短,对卵巢功能的影响更小,近、远期并发症发生率更低。在再次妊娠者围生期妊娠结局方面,两种止血方式未见差异。