[1]牟凤萍*,屈清华.双侧子宫动脉上行支结扎在中央性前置胎盘剖宫产术中大出血的应用研究[J].中国计划生育和妇产科,2017,(8):31-34.
　MOU Feng-ping*,QU Qing-hua.Application of bilateral ascending uterine artery ligation in the treatment of massive hemorrhage in cesarean section of placenta praevia centralis[J].Chinese Journal of Family Planning & Gynecotokology,2017,(8):31-34.
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双侧子宫动脉上行支结扎在中央性前置胎盘剖宫产术中大出血的应用研究
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《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2017年8期
页码:
31-34
栏目:
论著与临床
出版日期:
2017-08-25

文章信息/Info

Title:
Application of bilateral ascending uterine artery ligation in the treatment of massive hemorrhage in cesarean section of placenta praevia centralis
作者:
牟凤萍*; 屈清华
重庆市妇幼保健院妇产科
Author(s):
MOU Feng-ping*; QU Qing-hua
Department of Obstetrics and Gynecology, Chongqing Maternal and Child Health-Care Hospital, Chongqing 401120,P.R.China
关键词:
子宫动脉上行支结扎; 前置胎盘; 剖宫产术; 出血
Keywords:
ascending uterine artery ligation;  placenta praevia;  cesarean section;  hemorrhage
分类号:
R 719.8
摘要:
目的研究双侧子宫动脉上行支结扎应用在中央性前置胎盘剖宫产术中大出血的效果。 方法选取重庆市妇幼保健院2015年3月至2016年3月中央性前置胎盘剖宫产术中出现大出血情况的产妇120例，根据手术中采用的不同处置方式分为研究组63例和对照组57例。对照组术中采取常规手段止血，出血情况无法阻止时对髂内动脉进行结扎或切除子宫；研究组术中采取常规方法止血并对双侧子宫动脉上行支进行结扎。比较两组术中出血及输血情况、手术时间、术后恢复情况。结果研究组术中出血量［(36242 ± 9412) mL］显著低于对照组［( 60467 ±12438) mL］ (P＜005)；研究组术后24 h 出血量［(44243±12452) mL］显著低于对照组［(73456±21834) mL］ (P＜005)；研究组输血量［(18245±2653) mL］显著低于对照组［(33756±3478) mL］ (P＜005)；研究组的手术时间显著短于对照组（P＜005）；两组产后长期恢复情况比较差异无统计学意义（P＞005）。结论在中央性前置胎盘剖宫产术中出现大出血情况下对双侧子宫动脉上行支进行结扎来止血，能够缩短手术时间，减少产妇失血，减少输血量。
Abstract:
ObjectiveTo study the effect of bilateral ascending uterine artery ligation in placenta praevia centralis cesarean section with massive hemorrhage.Methods120 maternal with placenta praevia centralis hemorrhage who underwent cesarean section from March 2011 to March 2016 in Chongqing Maternal and Child Health-Care Hospital were divided into two groups according to different treatment used in the operation: study group(63 cases) and the control group(57 cases). The control group took conventional means of surgery to stop bleeding, and if the bleeding could not be stopped the internal iliac artery ligation or removal of the uterus was performed;the study group also adopted conventional methods to stop bleeding, and if the bleeding could not be stopped the bilateral ascending uterine artery branches were ligated.The amount of blood loss and blood transfusion, time of operation and short-term and long-term recovery were compared between the two groups.ResultsThe amount of blood loss in the study group ［(362. 42 ± 9412) mL］ was significantly lower than that in the control group［(60467 ± 12438) mL］ (P＜005). The 24h post operation bleeding volume in the study group ［(44243 ± 12452 )mL］ was significantly lower than that of the control group［(73456 ± 21834) mL ］(P＜005). The blood transfusion of the study group［(18245 ± 2653) mL ］was significantly lower than that of the control group［(33756 ± 3478) mL］ (P＜005); The operation time of the study group was significantly shorter than that of the control group(P＜005). There was no significant difference between the study group and the control group in long-term post-natal recovery(P＞005). ConclusionLigation of the ascending branch of bilateral uterine artery to stop bleeding in cesarean section of placenta praevia centralis can reduce time of operation, maternal blood loss and amount of blood transfusion.

参考文献/References:

［1］路思思，邹丽．凶险性前置胎盘致产后大出血的防范 ［J］．中国实用妇科与产科杂志，2014，30 （4）：256-259． ［2］段涛．前置胎盘:我们面临的挑战 ［J］．中国实用妇科与产科杂志，2014，30 （12）：916-917． ［3］李青，王志坚，余艳红，等．中国部分地区前置胎盘流行病学调查 ［J］．中国实用妇科与产科杂志，2014，30 （10）：786-790． ［4］RAO K P, BELOGOLOVKIN V, YANKOWITZ J, et al Abnormal placentation: Evidence-based diagnosis and management of placenta previa, placenta accreta, and vasa previa ［J］ Obstetrical & Gynecological Survey, 2012, 67(8): 503-519 ［5］华树生，杨慧燕，施灵美．结扎双侧子宫动脉上行支在中央性前置胎盘中的应用 ［J］．浙江预防医学，2014,26 （2）：194-195． ［6］FAN Dazhi, WU Song, WANG Wen, et al Prevalence of placenta previa among deliveries in mainland China: A PRISMA-compliant systematic review and meta-analysis ［J］ Medicine, 2016, 95(40): e5107 ［7］KIM L H, CAUGHEY A B, LAGUARDIA J C, et al Racial and ethnic differences in the prevalence of placenta previa ［J］ Journal of Perinatology : Official Journal of the California Perinatal Association, 2012, 32(4): 260-264 ［8］VRACHNIS N, IAVAZZO C, SALAKOS N, et al Uterine tamponade balloon for the management of massive hemorrhage during cesarean section due to placenta previa/increta ［J］. Clinical and Experimental Obstetrics & Gynecology, 2012, 39(2): 255-257. ［9］周巾，季淑英．介入治疗在凶险性前置胎盘剖宫产术中应用价值 ［J］．现代仪器与医疗，2015,21（6）：39-41． ［10］刘颖．子宫动脉栓塞术治疗产后大出血临床护理 ［J］．中国实用妇科与产科杂志，2015,31（10）：972． ［11］KOLLMANN M, GAULHOFER J, LANG U, et al. Placenta praevia: incidence, risk factors and outcome ［J］. The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2016, 29 (9): 1395-1398. ［12］SARFRAZ N, ANJUM S, GOGI M N, et al. Placenta previa major degree;obstetrical risk factors and maternal outcome ［J］. Medical Forum Monthly, 2013, 24 (4): 47-50.

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更新日期/Last Update: 2017-08-25