宫颈钳夹联合改良双合诊子宫压迫法治疗子宫下段收缩乏力性产后出血疗效

目的:探讨经阴道宫颈钳夹联合改良双合诊子宫压迫法治疗阴道分娩后子宫下段收缩差为主的宫缩乏力性出血的有效性。方法:采用随机对照研究设计,比较经阴道宫颈钳夹联合改良双合诊子宫压迫法(观察组64例)和持续按摩子宫联合宫缩剂(对照组64例)作为二线治疗方法的临床效果。结果:观察组止血有效61例,有效率为95.3%,对照组止血有效53例,有效率为82.8%,止血有效率、止血起效时间、出血量、住院天数、住院费用、需要输血率、需手术止血率、转入ICU率,观察组均优于对照组(P<0.05)。结论:阴道宫颈钳夹联合改良双合诊子宫压迫法治疗作为子宫下段收缩差为主的宫缩乏力性产后出血的二线治疗方法效果肯定,适用于在基层医院使用。

改良子宫压迫缝合术在治疗剖宫产术中子宫收缩乏力性出血中的临床应用

目的探讨改良子宫压迫缝合术在治疗剖宫产术中子宫收缩乏力性出血中的临床效果。方法选取2012年10月至2014年10月玉林市第二人民医院收治的76例行剖宫产术子宫收缩乏力性出血产妇为研究对象,根据随机数字表法分为观察组与对照组,各38例。观察组给予改良子宫压迫缝合术治疗,对照组给予子宫动脉结扎法治疗。观察与评价两组产妇的止血效果、手术时间、术中出血量、术后2 h出血量及术后并发症的发生情况。结果观察组的止血总有效率显著高于对照组[94.8%(36/38)比76.3%(29/38)],差异有统计学意义(P<0.05);观察组,术中出血量、术后2 h出血量均显著少于对照组[(558±86)mL比(958±125)mL,(42±10)mL比(81±13)mL],差异有统计学意义(P<0.05);观察组并发症发生率显著低于对照组[5.3%(2/38)比21.1%(8/38)],差异有统计学意义(P<0.05)。结论在剖宫产术中实施改良子宫压迫缝合术,能有效预防或减少剖宫产术中出血量、术后的出血量,且能有效减少并发症的发生,值得推广。

改良子宫压迫缝合术治疗剖宫产术中子宫收缩乏力性出血效果观察

目的观察改良子宫压迫缝合术治疗剖宫产术中子宫收缩乏力性出血的效果。方法该院2014年1月至2016年12月收治的100例剖宫产术中子宫收缩乏力性出血的产妇,随机分为研究组与对照组各50例,对照组采用传统子宫动脉结扎术治疗,研究组采用改良子宫压迫缝合术治疗,比较两组止血效果、手术时间、术中出血量、产后2小时出血量及并发症发生情况。结果研究组止血总有效率94.0%,高于对照组的76.0%;并发症发生率6.0%,低于对照组的22.0%;术中出血量、产后2小时出血量均少于对照组;差异均有统计学意义(P<0.05)。手术时间两组接近,差异无统计学意义(P>0.05)。结论剖宫产术中子宫收缩乏力性出血应用改良子宫压迫缝合术,止血效果较好,可减少术中及产后出血量,降低并发症发生率。

超声检查与临床评价在子宫切除术前预测子宫重量

The purpose of this study was to determine the most accurate method in estimating the preoperative uterine weight of enlarged nongravid uteri. Study design: We performed a retrospective review of 1238 patients who were premenopausal and underwent hysterectomy for benign indications between January 1993 and July 1999. Eight hundred and sixty four patients were selected to include only those that had both a reported bimanual assessment of preoperative uterine size and an ultrasonography report with all 3 estimated uterine dimensions. Reported uterine sizes on bimanual examination were converted to clinical weight (CWT). Two different calculations were used to estimate uterine weight from ultrasound measurements (UWT 1 and 2). Actual uterine weights (AWT) in pathology reports were then compared with the findings of bimanual assessment and the calculated weights to determine which method is the best predictor of AWT. Simple linear regression analysis was used to measure and compare how closely the estimated weights predicted the actual weight. Predictive residuals sum of squares (PRESS) was then used to determine the best predictor of actual weight. Results: After exploring the data using linear modeling, all 3 estimated weights were significantly correlated to the actual weight when compared, but PRESS scores showed that the clinical weight estimate was superior by far compared with the other 2. Conclusion: In this study, bimanual assessment was shown to be the most accurate method of preoperative uterine weight estimation. Ultrasound examination may not be routinely needed when deciding the route of hysterectomy based on estimated weight.

多样式改良Cho缝合法在剖宫产术中的应用价值

目的探讨多样式改良Cho缝合法在剖宫产术中的应用价值。方法将2017年3月至2019年3月本院择期剖宫产术中子宫下段血窦丰富,胎儿娩出后30 s内切口出血达100 ml及以上、无伤口延裂、非前置胎盘患者38例分为两组,研究组(20例)采用多样式改良Cho缝合,对照组(18例)采用传统缝合,进行回顾性分析。结果研究组子宫切口止血的手术时间短于对照组[(17.1±3.9)min,(20.8±4.8)min;P<0.05],术中出血量小于对照组[(237.5±64.6)ml,(302.8±91.5)ml;P<0.05],术后第2天白细胞水平低于对照组[(10.18±2.33)×10~9/L,(12.20±3.19)×10~9/L;P<0.05],关闭宫腔后切口渗血率低于对照组[10%(2/20),44.5%(8/18);P<0.05],子宫动脉上行支结扎率低于对照组[5%(1/20),33.3%(6/18);P<0.05],两组术后住院时间比较,差异无统计学意义(P>0.05)。结论多样式改良Cho缝合法有利于剖宫产术中子宫切口止血,可减少手术时间及手术出血量,感染风险降低。