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目的探讨改良B-Lynch缝合术在治疗剖宫产难治性产后出血中的临床效果。方法选取2008年1月-2014年1月该院治疗的难治性产后出血的患者118例作为研究对象。根据临床治疗方案的不同的,将所有患者随机分为3组,38例患者采用常规宫腔纱条填塞术进行治疗(对照组),40例行常规子宫动脉结扎术(常规组),40例患者采用改良B-Lynch缝合术进行治疗(实验组),比较各组患者的各阶段临床情况,评估治疗效果及比较患者术后并发症情况。结果在各个阶段,常规组及实验组在各个阶段的出血量均低于对照组,有统计学差义(P<0.05)。然而,常规组与实验组比较无统计学意义(P>0.05);治疗效果评估当中,同上述结果类似,常规组与实验组患者的止血失败、子宫切除、术后腹痛等例数均低于对照组患者,差异有统计学意义(P<0.05)。在对患者术后并发症发生情况比较分析中发现,常规组及实验组患者发生术后腹痛的例数及产褥感染的例数低于对照组患者,差异有统计学意义(P<0.05)。结论在对剖宫产难治性产后出血的治疗方法当中,子宫动脉结扎术对术者的要求较高,且影响子宫血流供应,而采用改良B-Lynch缝合术,操作简单,成功率高,不影响子宫的血流供应,保留子宫生理和生殖功能。采用改良B-Lynch缝合术进行治疗的患者比采用常规宫腔纱条填塞术进行治疗的患者出血量更低,治疗效果更好,并发症发生更少,能有效保留患者生育能力,因此,改良B-Lynch缝合术值得在临床应用中特别是基层医院推广和使用。
Objective To investigate the clinical effect of modified B-Lynch suture in the treatment of refractory postpartum hemorrhage in cesarean section. Methods A total of 118 patients with refractory postpartum hemorrhage treated in our hospital from January 2008 to January 2014 were selected as the study objects. All patients were randomly divided into three groups according to the clinical treatment plan. Thirty-eight patients were treated with conventional uterine gauze packing (control group), 40 patients underwent routine uterine artery ligation (routine group) and 40 patients The patients were treated with modified B-Lynch suture (experimental group). The clinical status of each group was compared and the therapeutic effect was evaluated and the postoperative complications were compared. Results In each stage, the amount of bleeding in routine and experimental groups was lower than that in control group (P <0.05). However, there was no significant difference between the conventional group and the experimental group (P> 0.05). Among the evaluation of the treatment effect, similar to the above results, the number of cases of hemostasis, hysterectomy and postoperative abdominal pain were lower in the conventional group and the experimental group The control group patients, the difference was statistically significant (P <0.05). Comparing the postoperative complications of the patients, we found that the incidence of postoperative abdominal pain and the number of puerperal infection in the routine group and the experimental group were lower than those in the control group (P <0.05) . Conclusion In the treatment of refractory postpartum hemorrhage in cesarean section, uterine artery ligation requires a high surgeon and affects the uterine blood supply. However, with improved B-Lynch suture, the operation is simple and the success rate is high , Does not affect the uterine blood supply, retention of uterine physiology and reproductive function. Patients treated with modified B-Lynch sutures performed less bleeding and had better outcomes and fewer complications than patients treated with conventional uterine tamponade, which effectively preserved patient fertility. Therefore, improvements B-Lynch suture deserves promotion and use in clinical application, especially in primary hospitals.