中央性前置胎盘剖宫产术中大出血行双侧子宫动脉上行支结扎和“8”字缝合止血的对比研究

王小亚1 ，田新玲2 *

（1.渭南市第一医院，陕西 渭南，714000；2.铜川市中医医院，陕西 铜川，727000）

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摘要：

目的 对比分析中央性前置胎盘（PPC）剖宫产术中大出血采用双侧子宫动脉上行支结扎和“8”字缝合止血的临床疗效 及预后。方法 选取2013 年6 月至2017 年6 月我院收治的PPC 剖宫产术中大出血患者80 例为研究对象。根据患者采用的 止血术式的不同将患者分为结扎组（44 例，采用双侧子宫动脉上行支结扎术）及缝合组（36 例，采用“8”字缝合术止血+宫腔 填塞）。比较两组患者的出血情况、治疗效果及预后情况。结果 与缝合组比较，结扎组术中出血量及术后24 h 出血量明显更 少，治愈率明显更高，输血率、子宫切除率、术后并发症及VAS 评分明显更低（P约0.05）。结论 双侧子宫动脉上行支结扎术应 用于中央性前置胎盘剖宫产术中大出血临床效果满意，安全性高，有助于促进患者康复，减轻手术痛苦，改善预后，值得临床 推广与应用。

关键词：中央性前置胎盘；剖宫产；双侧子宫动脉上行支结扎；“8”字缝合止血

中图分类号：R719.8文献标志码：A文章编号：2096-1413(2018)03-0141-03

Comparative study of bilateral ascending uterine arteries ligation and "8" suture hemostasis in placenta previa centralis hemorrhage
patients with cesarean section

WAGN Xiao-ya1, TIAN Xin-ling2 *
(1. the First Hospital in Weinan, Weinan 714000; 2. Traditional Chinese Medicine Hospital of Tongchuan, Tongchuan 727000, China)

ABSTRACT: Objective To compare and analyze the clinical effects and prognosis of bilateral ascending uterine arteries ligation and "8" suture hemostasis in placenta previa centralis (PPC) hemorrhage patients with cesarean section. Methods Eighty PPC hemorrhage patients with cesarean section admitted in our hospital from June 2013 to June 2017 were selected as the study objects. All the patients were divide into ligation group (44 cases, received bilateral ascending uterine arteries ligation) and suture group (36 cases, accepted "8" suture hemostasis+uterine cavity packing) according to different hemostasis methods. The bleeding, therapeutic effects and prognosis were compared between the two groups. Results Compared with the suture group, the intraoperative blood loss volume and postoperative 24 h blood loss volume were less, the cure rate was higher, the rates of blood transfusion and hysterectomy, postoperative complications, and VAS scores were significantly lower in the ligation group (P<0.05). Conclusion Bilateral ascending uterine arteries ligation in PPC hemorrhage patients with cesarean section has satisfactory clinical effect. It has high safety, and it is helpful to promote the recovery of patients, relieve the pain of operation and improve the prognosis, which is worth popularizing and applying in clinic.
KEYWORDS: placenta previa centralis (PPC); cesarean section; bilateral ascending uterine arteries ligation; "8" suture hemostasis

参考文献：
[1] TSAI HJ.Terminology of "cesarean section ectopic pregnancy" and " placenta previa and accrete"[J].Taiwan J Obstet Gynecol,2016,55(5): 760.
[2] 吕芳,方和金,万淑梅,等.腹腔镜下子宫动脉上行支血流阻断辅助 子宫肌瘤剔除术对卵巢功能的影响[J].山西医药杂志,2016,45(8):919-921.
[3] 和青森,杨建敏.卡前列素氨丁三醇应用时机对中央性前置胎盘剖宫产妇产后出血及血流动力学的影响[J].中国药房,2017,28(11):1535-1537.
[4] 李晓燕,王晓黎,李蕾,等.低位腹主动脉球囊阻断在凶险型前置胎盘中的应用价值[J].国际妇产科学杂志,2016,43(3):291-294.
[5] 何冰君,曹睿.剖宫产妇疼痛及产后康复的影响因素分析及临床干预[J].西部医学,2016,28(10):1474-1477.
[6] 刘丽霞.凶险型前置胎盘产后出血诊治分析[J].中国煤炭工业医学杂志,2016,19(1):43-45.
[7] 刘杰,李巨.剖宫产术后出血二次剖腹探查术24 例分析[J].解放军医学院学报,2016,37(9):940-943.
[8] 杨学芳,周菊英.宫腔纱条填塞法治疗中央型前置胎盘剖宫产术中大出血[J].西南国防医药,2016,26(7):739-741.
[9] 周桂云,申薇.子宫压缩缝合术治疗剖宫产产后出血的效果评价[J].河北医药,2017,39(9):1403-1404.
[10] 唐莉,代炳梅,钟文彬,等.前置胎盘合并胎盘植入危险因素分析及子宫动脉上行支结扎对母婴结局的影响[J].新乡医学院学报,2017,34(1):43-46.
[11] 王振辉.截断性子宫动脉上行支结扎加宫颈提拉式缝合在前置胎盘剖宫产术中宫颈管顽固性出血的应用[J].医学临床研究,2017,34(2):395-397.
[12] 朱诚程,倪观太,周毅惠,等.腹腔镜下保留子宫动脉上行支的子宫次全切除术式探讨[J].山西医药杂志,2016,45(3):276-277.