Clinical effect of ligation of descending uterine artery ligation combined with lower uterine compression suture in the treatment of bleeding during cesarean section in patients with dangerous placenta previa
Clinical effect of ligation of descending uterine artery ligation combined with lower uterine compression suture in the treatment of bleeding during cesarean section in patients with dangerous placenta previa
张萍 1索辉 1王园园 1秦婷 1曹妍妍 2田园
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作者信息
1. 开封一五五医院妇产科，开封 475000
2. 开封市人民医院妇产科，开封 475000
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摘要
目的 探究子宫动脉下行支结扎术(DUAL)联合子宫下段压迫缩窄缝合(LUCS)治疗凶险性前置胎盘(PPP)患者剖宫产术中出血的临床效果。 方法 本研究为病例对照研究，选取2020年6月至2023年6月开封一五五医院妇产科收治的100例PPP剖宫产术中出血患者，年龄(34.21±3.57)岁，年龄范围为24～42岁。根据不同的止血方法将患者分为B-Lynch缝合组与DUAL联合LUCS组，每组50例。B-Lynch缝合组采用改良B-Lynch缝合术及子宫下段纱布填塞进行止血，DUAL联合LUCS组采用DUAL术与LUCS进行止血。比较两组患者子宫切除率、子宫动脉栓塞率、手术用时、术中出血量、术后24 h失血量、术中输血量、住院时间、缩宫素、卡前列素氨丁三醇使用情况、恶露持续时间及术后并发症发生情况。 结果 DUAL联合LUCS组患者子宫切除率[4.0%(2/50)]及子宫动脉栓塞率[6.0%(3/50)]均低于B-Lynch缝合组[16.0%(8/50)、22.0%(11/50)]，差异有统计学意义(P<0.05)。DUAL联合LUCS组患者手术用时[(88.75±4.94)min]、术中出血量[(1 247.13±108.66)ml]、术后24 h出血量[(1 550.14±110.55)ml]、术中输血量[(703.52±89.31)ml]均少于B-Lynch缝合组[(108.95±5.25)min、(1 667.54±134.67)ml、(2 160.88±154.56)ml、(1 051.42±102.65)ml]，差异有统计学意义(P<0.05)。DUAL联合LUCS组患者缩宫素使用量及恶露持续时间与B-Lynch缝合组比较，差异无统计学意义(P>0.05)；DUAL联合LUCS组患者住院时间[(9.66±2.21)d]短于B-Lynch缝合组[(12.85±2.23)d]，卡前列素氨丁三醇使用量[(557.31±36.97)μg]少于B-Lynch缝合组[(723.56±52.14)μg]，差异有统计学意义(P<0.05)。DUAL联合LUCS组患者并发症发生率与B-Lynch缝合组比较，差异无统计学意义(P>0.05)。 结论 DUAL联合LUCS用于PPP剖宫产术中出血患者可快速止血，手术时间短，可减少术中及术后24 h失血量，减少子宫切除及子宫动脉栓塞的发生，缩短手术用时及住院时间，且具有较好的手术安全性，可用于PPP剖宫产术中出血患者的治疗。 Objective To investigate the clinical effect of descending uterine artery ligation(DUAL)combined with lower uterine compression suture(LUCS)in the treatment of hemorrhage during cesarean section in patients with dangerous placenta previa(PPP). Methods This study was a case-control study, a total of 100 patients with hemorrhage during PPP cesarean section were selected from the department of Obstetrics and Gynecology of Kaifeng 155 Hospital from June 2020 to June 2023, aged(34.21±3.57)years old, ranging from 24 to 42 years old.According to different hemostatic methods, the patients were divided into B-Lynch suture group and DUAL combined LUCS group, 50 cases in each group.B-Lynch suture group received modified B-Lynch suture and lower uterine gauze tamponage for hemostasis, while the DUAL combined with LUCS group received DUAL and LUCS for hemostasis.The hysterectomy rate, uterine artery embolization rate, operation time, intraoperative blood loss, 24 h postoperative blood loss, intraoperative blood transfusion, length of hospital stay, use of oxytocin, carprost tramine, duration of lochia and postoperative complications were compared between the two groups. Results The hysterectomy rate[4.0%(2/50)]and uterine artery embolization rate [6.0%(3/50)]in DUAL combined LUCS group were lower than those in B-Lynch suture group [16.0%(8/50)and 22.0%(11/50)], and the difference was statistically significant(P<0.05).Operation time [(88.75±4.94)min], intraoperative blood loss [(1 247.13±108.66)ml], 24 h postoperative blood loss [(1 550.14±110.55)ml], the amount of intraoperative blood transfusion [(703.52±89.31)ml]in DUAL combined LUCS group were lower than those in B-Lynch suture group [(108.95±5.25)min, (1 667.54±134.67)ml, (2 160.88±154.56)ml, (1 051.42±102.65)ml], the differences were statistically significant(P<0.05).There was no significant difference in the amount of oxytocin and duration of lochia in DUAL combined LUCS group compared with B-Lynch suture group(P>0.05).The length of hospital stay [(9.66±2.21)d]in DUAL combined LUCS group was shorter than that in B-Lynch suture group [(12.85±2.23)d], and the amount of carprost troamine [(557.31±36.97)μg]was lower than that in B-Lynch suture group [(723.56±52.14)μg], the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between DUAL combined LUCS group and B-Lynch suture group(P>0.05). Conclusions DUAL combined with LUCS can be used for rapid hemostasis in patients with bleeding during PPP cesarean section, short operation time, reduce intraoperative and postoperative 24 h blood loss, reduce the occurrence of hysterectomy and uterine artery embolization, shorten the operation time and hospital stay, and have good surgical safety, which can be used for the treatment of patients with bleeding during PPP cesarean section.
Abstract
Objective To investigate the clinical effect of descending uterine artery ligation(DUAL)combined with lower uterine compression suture(LUCS)in the treatment of hemorrhage during cesarean section in patients with dangerous placenta previa(PPP). Methods This study was a case-control study, a total of 100 patients with hemorrhage during PPP cesarean section were selected from the department of Obstetrics and Gynecology of Kaifeng 155 Hospital from June 2020 to June 2023, aged(34.21±3.57)years old, ranging from 24 to 42 years old.According to different hemostatic methods, the patients were divided into B-Lynch suture group and DUAL combined LUCS group, 50 cases in each group.B-Lynch suture group received modified B-Lynch suture and lower uterine gauze tamponage for hemostasis, while the DUAL combined with LUCS group received DUAL and LUCS for hemostasis.The hysterectomy rate, uterine artery embolization rate, operation time, intraoperative blood loss, 24 h postoperative blood loss, intraoperative blood transfusion, length of hospital stay, use of oxytocin, carprost tramine, duration of lochia and postoperative complications were compared between the two groups. Results The hysterectomy rate[4.0%(2/50)]and uterine artery embolization rate [6.0%(3/50)]in DUAL combined LUCS group were lower than those in B-Lynch suture group [16.0%(8/50)and 22.0%(11/50)], and the difference was statistically significant(P<0.05).Operation time [(88.75±4.94)min], intraoperative blood loss [(1 247.13±108.66)ml], 24 h postoperative blood loss [(1 550.14±110.55)ml], the amount of intraoperative blood transfusion [(703.52±89.31)ml]in DUAL combined LUCS group were lower than those in B-Lynch suture group [(108.95±5.25)min, (1 667.54±134.67)ml, (2 160.88±154.56)ml, (1 051.42±102.65)ml], the differences were statistically significant(P<0.05).There was no significant difference in the amount of oxytocin and duration of lochia in DUAL combined LUCS group compared with B-Lynch suture group(P>0.05).The length of hospital stay [(9.66±2.21)d]in DUAL combined LUCS group was shorter than that in B-Lynch suture group [(12.85±2.23)d], and the amount of carprost troamine [(557.31±36.97)μg]was lower than that in B-Lynch suture group [(723.56±52.14)μg], the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between DUAL combined LUCS group and B-Lynch suture group(P>0.05). Conclusions DUAL combined with LUCS can be used for rapid hemostasis in patients with bleeding during PPP cesarean section, short operation time, reduce intraoperative and postoperative 24 h blood loss, reduce the occurrence of hysterectomy and uterine artery embolization, shorten the operation time and hospital stay, and have good surgical safety, which can be used for the treatment of patients with bleeding during PPP cesarean section.
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