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目的探讨双侧子宫动脉上行支结扎术在中央性前置胎盘剖宫产术中大出血止血中的临床效果。方法选取2012年9月-2014年9月在该院妇产科住院并确诊为中央性前置胎盘,且在剖宫产术中出现大出血的70例患者为研究对象,随机分为对照组和观察组,每组各35例。对照组采用传统宫腔填塞法予以止血,观察组采用双侧动脉上行支结扎术进行止血。对比两组患者术中出血量、紧急输血率和手术时间;比较两组产后出血发生率、产褥感染发生率和血性恶露持续时间。对两组患者进行为期半年到一年的随访,比较两组患者月经恢复情况。结果对照组术中出血量为(1 298.23±262.57)ml,明显高于观察组的(661.03±98.84)ml;对照组术中紧急输血率高于观察组,手术时间长于观察组(P<0.05);对照组产后出血、产褥感染发生率和血性恶露持续时间明显高于观察组(P<0.05);两组患者月经恢复情况差异无统计学意义(P>0.05)。结论双侧子宫动脉上行支结扎术可有效控制剖宫产术中大出血,且术式简单,缩短手术时间,降低产后出血的发生率,对预防失血性休克有重要的作用,但对子宫复旧的影响仍需继续探讨。
Objective To investigate the clinical effect of bilateral uterine artery ligation in the hemostasis of massive hemorrhage in central placenta previa. Methods Seventy patients who were admitted to obstetrics and gynecology department of our hospital from September 2012 to September 2014 and were diagnosed as central placenta accreta and had massive bleeding during cesarean section were randomly divided into control group and control group Observation group, 35 cases in each group. The control group was treated with conventional intrauterine packing method to stop the bleeding. The observation group was stopped by bilateral artery ligation. Blood loss, emergency blood transfusion and operation time were compared between the two groups. The incidence of postpartum hemorrhage, the incidence of puerperal infection and the duration of bloody lochia were compared between the two groups. The two groups of patients for a period of six months to a year follow-up, compared two groups of patients with menstruation recovery. Results The blood loss in the control group was (1 298.23 ± 262.57) ml, which was significantly higher than that of the observation group (661.03 ± 98.84) ml. The emergency blood transfusion rate in the control group was higher than that in the observation group and the operation time was longer than that in the observation group ). The postpartum hemorrhage, the incidence of puerperal infection and the duration of bloody lochia in the control group were significantly higher than those in the observation group (P <0.05). There was no significant difference in the menstrual recovery between the two groups (P> 0.05). Conclusions The bilateral uterine artery ligation can effectively control the major bleeding in cesarean section. It has the advantages of simple operation, shortened operation time and reduced incidence of postpartum hemorrhage, which plays an important role in preventing hemorrhagic shock. However, Impact still need to continue to explore.