论文部分内容阅读
目的探讨凶险型前置胎盘患者行剖宫产术时保留子宫的手术方式。方法回顾性分析2010年10月至2013年12月住院分娩的凶险型前置胎盘患者48例,其中2010年10月至2011年10月入住患者16例作为对照组,2011年11月至2013年12月入住的患者32例作为研究组。对照组行传统子宫下段横切口剖宫产,胎盘娩出后胎盘附着面可吸收线间断缝合止血,如出血汹涌难以控制立即行子宫切除术。研究组行子宫下段横切口剖宫产术,但子宫切口适当上移,尽量手取胎盘,之后尽量下推子宫膀胱反折腹膜,在手指引导下,可吸收线自宫颈外口水平以上间断缝合子宫下段数针止血,检查宫腔内胎盘附着面有出血汹涌处对症缝合,然后放置子宫下段水囊一枚压迫止血。如遇胎盘剥离困难,则钳夹胎盘面,切除胎盘组织,创面可吸收线缝合。经以上处理仍出血汹涌,则立即行子宫切除术。比较两组术中失血量及子宫切除率。结果对照组术中失血量(6 600±721)ml,子宫切除率68.7%;研究组术中失血量(3 100±432)ml,子宫切除率25.0%。两组相比,研究组术中失血量少,子宫切除率低,差异有统计学意义(P均﹤0.01)。结论改良后的手术方式治疗凶险型前置胎盘效果显著,可减少术中失血量,降低子宫切除率。
Objective To investigate the surgical methods of preserving the uterus during cesarean section in patients with dangerous placenta previa. Methods Retrospective analysis of 48 cases of dangerous placenta previa admitted to hospital from October 2010 to December 2013, of which 16 were admitted to the hospital from October 2010 to October 2011 as the control group. From November 2011 to 2013 32 patients admitted in December as a research group. The control group underwent conventional uterine incision cesarean section, the placenta attached to the placenta attached to the surface can absorb intermittent suture hemostasis, such as bleeding difficult to control hysterectomy. The study group underwent transverse cesarean section of the lower uterine segment, but the uterine incision appropriate move up, try to take the placenta, and then try to push down the uterus bladder peritoneal buckling, under the guidance of the finger, the absorbable line from the cervix outside the level of more than intermittent suture The next few needle hemostasis, check the intrauterine surface of the placenta attached to bleeding raging Symptomatic suture, and then placed a lower uterine sac compression hemostasis. In case of placental detachment difficulties, then placenta accreta, removal of placental tissue, wound absorbable suture. After the above treatment is still bleeding turbulent, then hysterectomy. Blood loss and hysterectomy were compared between the two groups. Results The intraoperative blood loss (6 600 ± 721) ml and hysterectomy in the control group was 68.7%. The blood loss in the study group was 3 100 ± 432 ml and the hysterectomy rate was 25.0%. Compared with the two groups, the study group less blood loss, hysterectomy rate, the difference was statistically significant (P all <0.01). Conclusion The improved surgical treatment of dangerous placenta previa significant effect, can reduce intraoperative blood loss and reduce hysterectomy.