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目的 探讨晨笛网压缝合术替代子宫切除术治疗难治性产后出血的安全及有效性.方法 对2012年3月-2014年12月该院收治的因难治性产后出血先行常规止血措施后效果不佳转而实施晨笛网压缝合术的患者15例进行回顾性分析并作为观察组,同时选取同期在该院因难治性产后出血先行常规止血措施后效果不佳转而实施子宫切除术的患者15例作为对照组.分析两组患者术后止血效果、实施治疗术前、术中、术后1h出血量和输血量、手术时间、术后止血时间和术后到下床活动时间,术前和术后1个月卵泡生成激素(FSH)、黄体生成激素(LH)和雌二醇(E2)水平以及术后不良事件发生比例.结果 经对应手术方式后,两组患者均达到止血效果,且均无死亡病例.观察组术中、术后1h出血量均显著少于对照组,差异有统计学意义(t=19.682、7.132,均P＜0.05);观察组术中输血量明显少于对照组,差异有统计学意义(t=11.459,P＜0.05).观察组手术时间、术后止血时间和术后下床活动时间均明显短于对照组,且差异均有统计学意义(t=6.164、7.822、9.579,均P＜0.05).术后1个月两组患者FSH、LH和E2水平与术前相比,差异均无统计学意义(P＞0.05),且术后组间相比,FSH、LH和E2水平差异均无统计学意义(P＞0.05).观察组患者术后子宫均得到保留,对照组均摘除子宫;对照组术后腹痛、尿失禁、抑郁患者、性生活质量下降患者的发生比例均显著高于观察组,差异有统计学意义(x2=4.821、3.333、3.333、7.033,均P＜0.05),且观察组患者仍有生育能力,对照组丧失生育能力.结论 在常规止血措施无效的情况下,晨笛网压缝合术可替代子宫切除术治疗难治性产后出血,该手术可减轻术中痛苦,保留子宫和生育能力,有利于患者身心健康.“,”Objective To explore the safety and efficacy of Chendi netlike compression suture replacement hysterectomy in treatment of refractory postpartum hemorrhage.Methods A retrospective analysis was carried out on 15 patients with refractory postpartum hemorrhage treated by Chendi netlike compression suture due to ineffectiveness of routine hemostasis in the hospital from March 201 to to December 2014,and these patients were selected as observation group.During the same period,15 patients with refractory postpartum hemorrhage were selected as control group who were treated with hysterectomy due to ineffectiveness of routine hemostasis.The postoperative hemostatic effects,the volumes of bleeding and the volumes of blood transfusion before operation,during operation,and at 1 hour after operation,operation time,postoperative hemostasis time,postoperative ambulation time,follicle stimulating hormone (FSH),luteinizing hormone (LH),and estradiol (E2) levels before operation and at one month after operation,and the incidence rates of postoperative adverse events in the two groups were analyzed.Results After the corresponding surgical therapy,hemostasis was achieved in the two groups,and there was no death.The volumes of bleeding during operation and at one hour after operation in observation group were statistically significantly less than those in control group (t =19.682,7.132,both P＜0.05).The volume of blood transfusion during operation in observation group was statistically significantly less than that in control group (t =11.459,P＜0.05).The operation time,postoperative hemostasis time,and postoperative ambulation time in observation group was statistically significantly shorter than that in control group (t =6.164,7.822,9.579,all P＜0.05).There was no statistically significant difference in the levels of FSH,LH,and E2 between one month after surgery and before operation in the two groups (P＞0.05),and there was no statistically significant difference in the levels of FSH,LH,and E2 at one month after surgery between two groups (P＞0.05).The uteruses of patients in observation group were preserved after operation,while the uteruses of patients in control group were removed.The incidence rates of postoperative abdominal pain,urinary incontinence,depression,decreased quality of sexual life in control group were statistically significantly higher than those in observation group (x2 =4.821,3.333,3.333,7.033,all P＜0.05).The patients in observation group still had fertility,while the patients in control group lost fertility.Conclusion When conventional hemostatic measures are ineffective,Chendi netlike compression suture can substitute hysterectomy to treat refractory postpartum hemorrhage,the surgery can reduce intraoperative pain and preserve uterus and fertility,which is good for physical and mental health of the patients.