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目的探讨子宫下段暂时性环扎在中央型前置胎盘术中出血处理的应用效果及安全性。方法回顾性分析2011年6月至2015年6月绵阳市妇幼保健院收治的中央型前置胎盘患者90例的临床资料,根据止血方式将其分为观察组(54例)与对照组(36例),对照组产妇采取常规止血治疗,观察组产妇在剥离胎盘前及子宫局部处理或全切除前,迅速使用一次性硅胶尿管环扎子宫下段阻断子宫体血液供应,在子宫体血运阻断后进行常规止血操作,术后放开环扎尿管恢复子宫血供(排除子宫已切除患者),比较两组产妇治疗效果及临床结局。结果两组产妇干预前出血量比较差异无统计学意义(P>0.05);观察组产妇卡前列素氨丁三醇用量、术中总出血量、总输血量、子宫切除率明显低于对照组,差异有统计学意义(P<0.05);两组患者止血成功率均为100%;两组患者子宫坏死、切口感染、宫腔积血等并发症发生率比较,差异无统计学意义(P>0.05)。结论子宫下段暂时性环扎术治疗前置胎盘分娩术中出血患者,止血效果较好,能迅速降低术中出血量,有效减少患者药物应用及输血量,止血成功率较高,同时子宫坏死等并发症发生率较低,应用安全性较高。
Objective To investigate the effect and safety of temporary cerclage of lower uterus in the treatment of bleeding in central placenta previa. Methods The clinical data of 90 patients with central placenta previa admitted to Mianyang MCH from June 2011 to June 2015 were retrospectively analyzed. According to the method of hemostasis, they were divided into observation group (54 cases) and control group (36 cases) In the control group, the maternal women received conventional hemostasis. Before the treatment group peeled off the placenta and local treatment or total resection of the uterus, the disposable ureteral cerclage was used to block the uterine blood supply immediately. After blocking the conventional hemostasis operation, release the cerclage catheter to restore uterine blood supply (excluding the uterus has been excised), compare the two groups of maternal treatment and clinical outcomes. Results There was no significant difference in the amount of bleeding between the two groups before intervention (P> 0.05). The amounts of carboprost, trometamol, total blood loss, total blood transfusion and hysterectomy in the observation group were significantly lower than those in the control group (P <0.05). The success rate of hemostasis in both groups was 100%. There was no significant difference in complication rates of uterine necrosis, incision infection and uterine hemorrhage between the two groups (P > 0.05). Conclusions Temporary cerclage of the lower uterus in the treatment of hemorrhage in the preoperative placenta delivery has good hemostasis effect and can quickly reduce the amount of intraoperative blood loss, effectively reduce the drug application and blood transfusion in patients with high success rate of hemostasis and uterine necrosis The incidence of complications is low, the application of safety is higher.