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目的探讨晨笛网压缝合术(Chen-Di Network Compression Suture CNCS)在难治性产后出血治疗中的应用价值。方法回顾分析晨笛网压缝合术(CNCS)对17例难治性产后出血患者的临床治疗,评价手术疗效及手术安全性。结果 17例行CNCS后,子宫活动性出血5~10min停止,观察10~30min阴道无明显流血,关腹,均成功保留患者子宫。术后5d垂体激素、甲状腺激素、肾上腺激素及女性激素各项数值均在正常范围;MRI:术后4d宫壁见散在点状信号,未见宫腔积液,术后46d宫壁肌层信号均匀,宫内膜线清晰;超声检查:术后42d子宫前后径3.5~4.5cm,宫壁肌层回声均匀,复旧形态良好;宫腔镜:术后3~5个月,宫腔无粘连,内膜形态正常,输卵管开口清晰。随访:17例患者术后42d复查,恶露均已净;7例仍在哺乳期,其余病例停止哺乳后1~2个月经恢复正常。结论 CNCS在难治性产后出血治疗中具有重要应用价值,具有止血快、无术后并发症的特点,在产后出血中对经子宫按压、促宫缩药物注射仍无法止血的乏力性产后出血患者,可选择CNCS进行急救。
Objective To investigate the value of Chen-Di Network Compression Suture (CNCS) in refractory postpartum hemorrhage. Methods The clinical treatment of 17 patients with intractable postpartum hemorrhage by morning wire mesh suture closure (CNCS) was retrospectively analyzed. The curative effect and operative safety were evaluated. Results 17 cases of CNCS, active uterine bleeding 5 to 10min to stop, observe the vagina 10 ~ 30min no significant bleeding, the abdomen, were successfully retained the uterus. The values of pituitary hormone, thyroid hormone, adrenal hormones and female hormones were within the normal range on the 5th postoperative day. MRI: Dispersion of punctate signal appeared on the parietal wall 4 days after operation, no uterine effusion was observed. On the 46th day after operation, Uniform, clear endometrial line; ultrasound examination: 42d postoperative uterine anteroposterior diameter 3.5 ~ 4.5cm, uterine wall echo uniform, good shape of the old; Hysteroscopy: 3 to 5 months after surgery, the uterine cavity without adhesions, Endometrial morphology is normal, tubal openings clear. Follow-up: Seventeen patients were reviewed 42 days after operation, and the lochia were all net. Seven patients were still breast-feeding, and the other patients returned to normal 1-2 months after stopping breast-feeding. Conclusion CNCS has an important value in the treatment of intractable postpartum hemorrhage. It has the characteristics of quick hemostasis and no postoperative complications. In postpartum hemorrhage, the patients with postpartum hemorrhage due to uterine compression and uterine contracting drug injection are still unable to stop bleeding , Choose CNCS for first aid.