【摘要】 目的探讨分析止血带捆绑下子宫下段环形蝶式缝扎术在凶险性前置胎盘伴胎盘植入患者中的临床应用效果。方法选取2016年12月至2018年12月深圳市龙华区人民医院妇产科收治分娩的72例凶险性前置胎盘伴胎盘植入患者作为研究对象。根据随机数字表法将其分为试验组(n=36)和常规组(n=36)。试验组采用止血带捆绑下子宫下段环形蝶式缝扎术进行胎盘处理,常规组采用常规胎盘处理和子宫内压迫止血。统计两组的手术时间、术中出血量、术后24h累计出血量、修正血红蛋白(Hb)值、住院时间等情况,并比较两组的子宫切除率、红细胞输注、输注量以及术后并发症发生情况。结果试验组术中出血量、产后24h累计出血量以及修正Hb值均低于常规组,住院时间短于常规组,差异具有统计学意义(P<0.05)。试验组的子宫切除率为5.56%,低于常规组的22.22%,差异具有统计学意义(P<0.05)。试验组红细胞输注率为88.89%,与常规组的97.22%比较,差异无统计学意义(P>0.05);试验组的平均红细胞输注量为(645.2±56.1)mL,低于常规组的(794.7±75.3)mL,差异具有统计学意义(P<0.05)。试验组的术后并发症发生率为11.11%,与常规组的19.44%比较,差异无统计学意义(P>0.05)。结论对于凶险性前置胎盘伴胎盘植入患者,采用止血带捆绑下子宫下段环形蝶式缝扎术进行处理,能起到较好的止血效果,降低出血量,从而更好地保留患者的子宫和生育能力,具有一定的临床推广应用的价值。更多还原

【Abstract】 Objective To investigate the clinical effect of circular butterfly suture in lower segment of uterus with tourniquet binding in the treatment of pernicious placenta previa with placenta accreta. Methods 72 patients with pernicious placenta previa with placenta accreta who were admitted to the Department of Obstetrics and Gynecology of Longhua District People′s Hospital from December 2016 to December 2018 were selected as the research subjects. According to random number table method, they were divided into experimental group(n=36) and conventional group(n=36). The experimental group was treated with placenta by circular butterfly suture in the lower uterine segment with tourniquet binding, while the conventional group was treated with conventional placenta treatment and uterine compression hemostasis. The operative time, intraoperative blood loss, cumulative blood loss 24 h after operation, modified hemoglobin(Hb) value, length of hospital stay and other conditions of the two groups were counted, and the hysterectomy rate, erythrocyte infusion, infusion volume and postoperative complications of the two groups were compared. Results The amount of intraoperative blood loss, 24 h postpartum blood loss and modified Hb value in experimental group were lower than those in conventional group, and the length of hospital stay in experimental group was significantly shorter than that in conventional group(P<0.05).The hysterectomy rate of the experimental group was 5.56%, which was lower than that of the conventional group(22.22%), and the difference was statistically significant(P<0.05). The erythrocyte infusion rate of experimental group was 88.89%, compared with 97.22% of conventional group, and there was no statistical difference(P>0.05). The average erythrocyte infusion volume in the experimental group was(645.2±56.1) mL, which was lower than that in the conventional group(794.7±75.3) mL, and the difference was statistically significant(P<0.05). There was no difference in incidence of postoperative complications of 11.11% in the experimental group and 19.44% in the conventional group(P>0.05). Conclusions For patients with pernicious placenta previa with placenta accreta, the use of tourniquet binding under the lower uterine segment of the circular butterfly suture treatment, can play a better hemostatic effect, reduce the amount of bleeding, so as to better retain the patient′s uterus and fertility, has a certain clinical application value.更多还原