改良B-Lynch缝合治疗剖宫产产后出血68例临床分析(1)
【摘要】 目的 观察改良的B-Lynch缝合术治疗剖宫产产后岀血的临床效果。方法 选择我院2006年1月至2009年12月剖宫产术中发生宫缩乏力性出血病例98例,随机分为研究组68例,实施改良的B-Lynch缝合术进行治疗,对照组30例,采用传统方法治疗,观察两组手术时间、术中出血量、术中术后并发症等临床效果。结果 研究组治疗有效率、手术时间、术中出血量、产褥病率等与对照组比较差异有统计学意义(P<0.05)。无一例子宫切除,临床效果满意。结论 改良的B-Lynch缝合术用于治疗剖宫产产后出血,具有操作简单、安全,止血迅速,并能保留生育功能,是治疗剖宫产产后出血的有效方法。
【关键词】剖宫产;产后出血;改良的B-Lynch缝合术
Clinical analysis of 68 cases with improvedB-Lynch suture for postpartum hemorrhage of cesarean section
, 百拇医药
XU Hui,ZHOU Yuan,YAO Li.
Department of Obstetrics and Gynecology,Municipal Hospital of Zaozhuang,Shandong 277101,China
【Abstract】 Objective To observethe clinical efficacy of improved B-Lynch suturein the treatment of postpartum hemorrhage of cesarean section caused by uterine inertia.Methods There were 98 cases of postpartum hemorrhage duringcesarean section from 2006.1 to 2009.12.68 cases of postpartum hemorrhage of cesarean section treated with B-Lynch suture served as the study group.30 cases of parturient patients treated with tradition technique for postpartum hemorrhage of cesarean section were recruited as control group.Operation time,hemorrhage volume,puerperal morbidity and therapeutic efficacy between the two groups were compared.Results All cases in the study group were effectively stanched with preservation of uterine and no postoperative complication was found.The differences were significant for operation time,hemorrhage volume,puerperal morbidity and success rate between the study group and the control group(P<0.05).There was no hysterectomy in study group satisfac tory clinical results.Conclusion Improved B-Lynch suture technique is useful for its simplicity of application,life saving potential,relative safety and capacity for preserving the uterus and subsequent fertility.It is an effective treatment for postpartum hemorrhage during cesarean section.
, 百拇医药
【Key words】
Cesarean section; Postpartum hemorrhage; Improved B-Lynch suture technique
产后岀血是我国孕产妇死亡的首位原因,随着剖宫产率的不断增高,剖宫产术中术后大出血在产后岀血中又占了较大的比例,而剖宫产本身即是产后岀血的高危因素[1],对有高危因素或潜在大出血危险的患者,早期诊断和及时有效的处理是治疗的关键;能否保留子宫关系到将来产妇生育功能和生活质量。近年来兴起的子宫压迫缝合术是用于产后岀血治疗的一系列新方法,其中B-Lynch缝合术是最先被提出、应用最广泛、技术最成熟的方法,我们通过改良应用于有高危因素的剖宫产产后岀血的治疗,取得了满意的临床效果,现报告如下。
1 资料与方法
1.1 研究对象 选择我院自2006年1月至2009年12月住院分娩的有高危岀血因素的剖宫产术中子宫收缩乏力性岀血98例,年龄23~37岁,平均28.36岁,孕周37~42周,初产妇60例,经产妇38例,其中巨大儿35例,双胎26例,三胎2例,羊水过多20例,臀位15例,随机分为研究组68例,30例为对照组,两组在年龄、孕周、产次及新生儿出生体重等方面差异无统计学意义(P>0.05)。
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1.2 方法 两组患者均采用连续硬膜外麻醉,均行腹膜内子宫下段横切口剖宫产术,术中均表现为胎盘娩出后宫腔大量岀血,子宫呈“棉袋”状改变。研究组:迅速将子宫挽出腹腔,采用按摩子宫、应用宫缩剂等常规治疗无效,用手挤压宫体若加压后出血量减少可行改良的B-Lynch缝合术。选择子宫下段切口上缘约1~2 cm距切口左侧缘3~4 cm处进针,在子宫前壁由下向上垂直褥式缝合2~3针深达肌层至内膜下层,但不穿透蜕膜层,于宫底部距离左宫角3~4 cm处绕过宫底达子宫后壁,在子宫后壁左侧与前壁缝合相对应部位由上向下垂直褥式缝合2~3针(不穿透蜕膜层),出针后缝线连续向下至左侧低韧带上方相当于子宫下段切口水平自左向右水平褥式缝合1针在右侧低韧带上方出针,继续右半部分缝合,方法同子宫左半部但缝合方向相反,缝线在子宫右侧缘上方1~2 cm处出针,拉紧缝线后打结,打结时小心谨慎,缓慢渐进性拉紧缝线的首尾部,由第一助手排垫大网及肠管暴露术野,第二助手纵向挤压子宫后再打结,观察子宫色泽如转成红润、无岀血或岀血基本停止、生命体征平稳,再用可吸收线将子宫切口自左向右连续缝合,常规关腹。对照组应用按摩子宫、应用宫缩剂、宫腔填塞纱布、双侧子宫动脉上行支结扎等传统方法进行治疗。观察两组手术时间、术中术后出血量、术中输血情况、术中术后并发症,随访术后子宫复旧及月经恢复等临床效果。
1.3 出血量的计算方法 吸出出血量(吸净羊水并记录羊水量,将负压瓶内液体总量-羊水量)+纱布块数×纱布浸透前后重量差,按血液比重1.05换算为毫升数。, 百拇医药(徐 慧 周 原 姚 莉)
【关键词】剖宫产;产后出血;改良的B-Lynch缝合术
Clinical analysis of 68 cases with improvedB-Lynch suture for postpartum hemorrhage of cesarean section
, 百拇医药
XU Hui,ZHOU Yuan,YAO Li.
Department of Obstetrics and Gynecology,Municipal Hospital of Zaozhuang,Shandong 277101,China
【Abstract】 Objective To observethe clinical efficacy of improved B-Lynch suturein the treatment of postpartum hemorrhage of cesarean section caused by uterine inertia.Methods There were 98 cases of postpartum hemorrhage duringcesarean section from 2006.1 to 2009.12.68 cases of postpartum hemorrhage of cesarean section treated with B-Lynch suture served as the study group.30 cases of parturient patients treated with tradition technique for postpartum hemorrhage of cesarean section were recruited as control group.Operation time,hemorrhage volume,puerperal morbidity and therapeutic efficacy between the two groups were compared.Results All cases in the study group were effectively stanched with preservation of uterine and no postoperative complication was found.The differences were significant for operation time,hemorrhage volume,puerperal morbidity and success rate between the study group and the control group(P<0.05).There was no hysterectomy in study group satisfac tory clinical results.Conclusion Improved B-Lynch suture technique is useful for its simplicity of application,life saving potential,relative safety and capacity for preserving the uterus and subsequent fertility.It is an effective treatment for postpartum hemorrhage during cesarean section.
, 百拇医药
【Key words】
Cesarean section; Postpartum hemorrhage; Improved B-Lynch suture technique
产后岀血是我国孕产妇死亡的首位原因,随着剖宫产率的不断增高,剖宫产术中术后大出血在产后岀血中又占了较大的比例,而剖宫产本身即是产后岀血的高危因素[1],对有高危因素或潜在大出血危险的患者,早期诊断和及时有效的处理是治疗的关键;能否保留子宫关系到将来产妇生育功能和生活质量。近年来兴起的子宫压迫缝合术是用于产后岀血治疗的一系列新方法,其中B-Lynch缝合术是最先被提出、应用最广泛、技术最成熟的方法,我们通过改良应用于有高危因素的剖宫产产后岀血的治疗,取得了满意的临床效果,现报告如下。
1 资料与方法
1.1 研究对象 选择我院自2006年1月至2009年12月住院分娩的有高危岀血因素的剖宫产术中子宫收缩乏力性岀血98例,年龄23~37岁,平均28.36岁,孕周37~42周,初产妇60例,经产妇38例,其中巨大儿35例,双胎26例,三胎2例,羊水过多20例,臀位15例,随机分为研究组68例,30例为对照组,两组在年龄、孕周、产次及新生儿出生体重等方面差异无统计学意义(P>0.05)。
, http://www.100md.com
1.2 方法 两组患者均采用连续硬膜外麻醉,均行腹膜内子宫下段横切口剖宫产术,术中均表现为胎盘娩出后宫腔大量岀血,子宫呈“棉袋”状改变。研究组:迅速将子宫挽出腹腔,采用按摩子宫、应用宫缩剂等常规治疗无效,用手挤压宫体若加压后出血量减少可行改良的B-Lynch缝合术。选择子宫下段切口上缘约1~2 cm距切口左侧缘3~4 cm处进针,在子宫前壁由下向上垂直褥式缝合2~3针深达肌层至内膜下层,但不穿透蜕膜层,于宫底部距离左宫角3~4 cm处绕过宫底达子宫后壁,在子宫后壁左侧与前壁缝合相对应部位由上向下垂直褥式缝合2~3针(不穿透蜕膜层),出针后缝线连续向下至左侧低韧带上方相当于子宫下段切口水平自左向右水平褥式缝合1针在右侧低韧带上方出针,继续右半部分缝合,方法同子宫左半部但缝合方向相反,缝线在子宫右侧缘上方1~2 cm处出针,拉紧缝线后打结,打结时小心谨慎,缓慢渐进性拉紧缝线的首尾部,由第一助手排垫大网及肠管暴露术野,第二助手纵向挤压子宫后再打结,观察子宫色泽如转成红润、无岀血或岀血基本停止、生命体征平稳,再用可吸收线将子宫切口自左向右连续缝合,常规关腹。对照组应用按摩子宫、应用宫缩剂、宫腔填塞纱布、双侧子宫动脉上行支结扎等传统方法进行治疗。观察两组手术时间、术中术后出血量、术中输血情况、术中术后并发症,随访术后子宫复旧及月经恢复等临床效果。
1.3 出血量的计算方法 吸出出血量(吸净羊水并记录羊水量,将负压瓶内液体总量-羊水量)+纱布块数×纱布浸透前后重量差,按血液比重1.05换算为毫升数。, 百拇医药(徐 慧 周 原 姚 莉)