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目的探讨子宫交叉捆绑术治疗剖宫产术中难治性产后出血的有效性与安全性。方法回顾性分析重庆医科大学附属第一医院产科2010年10月至2013年9月应用子宫捆绑缝合术治疗的57例剖宫产术中难治性产后出血病例资料,根据缝合方法分为子宫交叉捆绑术组(n=35)与B-Lynch缝合术组(n=22),比较两组术中、术后2 h、术后24 h出血量以及住院天数、术后并发症及随访情况。结果 (1)交叉捆绑术组止血有效率97%,B-Lynch缝合术组为86%,两组比较差异有统计学意义(P<0.05)。(2)两组术中、术后2 h、术后24 h出血量及住院天数比较差异均有统计学意义(P<0.05)。(3)交叉捆绑术后随访现未发现并发症,B-Lynch缝合术后有1例发生宫腔粘连。(4)交叉捆绑术组术后随访期间有2例正常妊娠,B-Lynch缝合术组术后随访未发现再次妊娠的病例。结论剖宫产术中施行子宫交叉捆绑术是一种有效且安全的治疗剖宫产术中难治性产后出血的方法,而且其并发症少,对子宫的损伤小,值得临床推广应用。
Objective To investigate the effectiveness and safety of cross-bundling uterus in the treatment of intractable postpartum hemorrhage in cesarean section. Methods Retrospective analysis of 57 cases of intractable postpartum hemorrhage in cesarean section treated by uterine bundling and suturing in the First Affiliated Hospital of Chongqing Medical University from October 2010 to September 2013 were divided into three groups according to the method of suture: Binding group (n = 35) and B-Lynch suture group (n = 22) were enrolled in this study. The intraoperative, postoperative 2 h, postoperative 24 h blood loss, hospital stay, postoperative complications and follow-up were compared. Results (1) The effective rate of hemostasis was 97% in the cross-bundle group and 86% in the B-Lynch suture group, the difference was statistically significant (P <0.05). (2) There were significant differences in the amount of bleeding and hospital stay at 2 h, 2 h after operation and 24 h after operation (P <0.05). (3) There was no complication after follow-up with cross-bundling. One case of intrauterine adhesions occurred after B-Lynch suture. (4) There were 2 cases of normal pregnancy in the cross-bundling group during the follow-up period. No cases of re-pregnancy were found after follow-up in the B-Lynch suture group. Conclusion Cesarean section in the implementation of cross-bundling the uterus is an effective and safe treatment of refractory postpartum hemorrhage in cesarean section method, and its complications less damage to the uterus, worthy of clinical application.