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目的观察宫腔水囊压迫配合子宫动脉结扎术治疗前置胎盘剖宫产产后出血的效果。方法选取2010年1月—2016年12月采用宫腔水囊压迫配合子宫动脉结扎术治疗的剖宫产前置胎盘产妇30例作为观察组,选取采用宫腔填塞纱条配合子宫动脉结扎术30例产妇作为对照组。观察两组术中、术后出血量、活动性出血消失时间、宫腔水囊或盐水纱条留置时长;统计术后子宫切除、再出血、切口感染的发生率;两组均给予为期6个月的电话或门诊随访,统计子宫恢复不佳、宫腔粘连等情况的发生率。计量资料比较采用t检验,计数资料比较采用χ2检验,P<0.05为差异有统计学意义。结果观察组术中出血量(727.39±49.38)ml、术后出血量(187.25±13.42)ml、活动性出血消失时间(19.38±2.67)min及水囊、纱条留置时长(16.23±4.01)h均较对照组[(794.64±54.61)ml、(205.67±12.04)ml、(25.67±3.82)min、(21.08±3.51)h]短,且对比差异有统计学意义(P<0.05);两组均无新生儿窒息、死亡等恶性事件发生,观察组总并发症发生率为26.67%低于对照组40.00%,但对比差异无统计学意义(P>0.05)。结论宫腔水囊压迫配合子宫动脉结扎术较宫腔填充纱条治疗前置胎盘剖宫产产后出血效果佳,且操作简单,还能一定程度降低子宫切除率。
Objective To observe the effect of intrauterine compression combined with uterine artery ligation on the bleeding after cesarean delivery in the placenta previa. Methods From January 2010 to December 2016, 30 cases of cesarean section placenta previa with uterine balloon compression combined with uterine artery ligation were selected as the observation group. The intrauterine packing gauze with uterine artery ligation 30 Cases of maternal as a control group. The intraoperative and postoperative bleeding volume, the disappearance of active bleeding, the duration of intrauterine drainage or saline gauze retention were observed. The incidences of postoperative hysterectomy, rebleeding and incision infection were also calculated. Six patients in both groups were given 6 Month telephone or out-patient follow-up, statistics of poor uterine recovery, uterine adhesions and so on. Measurement data were compared using t test, count data were compared using χ2 test, P <0.05 for the difference was statistically significant. Results The intraoperative blood loss (727.39 ± 49.38) ml, postoperative bleeding volume (187.25 ± 13.42) ml, active bleeding disappearance time (19.38 ± 2.67) min and water bag, gauze retention time (16.23 ± 4.01) h (P <0.05). Compared with the control group [(794.64 ± 54.61) ml, (205.67 ± 12.04) ml, (25.67 ± 3.82) min, (21.08 ± 3.51) h], the difference was statistically significant No neonatal asphyxia, death and other malignant events occurred. The total complication rate in observation group was 26.67%, which was lower than that in control group (40.00%), but the difference was not statistically significant (P> 0.05). Conclusions The intrauterine compression combined with uterine artery ligation is superior to uterine filling gauze in treating postpartum hemorrhage of cesarean section in preplacental placenta and its operation is simple and can reduce the hysterectomy rate to a certain extent.