剖宫产术中子宫角部收缩乏力的原因及弓形动脉缝扎术的疗效分析

发布时间：2018-04-24 03:32

本文选题：剖宫产术 + 宫缩乏力　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：分析剖宫产术中发生子宫角部收缩乏力的原因，并探讨行弓形动脉缝扎术治疗的疗效。方法：收集中国人民解放军第二O二医院2013年9月至2013年12月期间，剖宫产术中发生经保守治疗无效的宫角部收缩乏力的病例，总共50例，分析50例患者的一般情况，包括年龄、孕周、孕次、产次、既往病史、子宫手术史、妊娠期合并症及并发症、新生儿体重及术中情况，探讨发生宫角部收缩乏力的原因。根据术中所见，有24例为单侧宫角部收缩乏力（简称A组），另26例为以单侧宫角部收缩乏力为主同时伴有子宫体收缩乏力（简称B组）。对A组中宫角部收缩乏力性出血较多的患者行单侧弓形动脉缝扎止血，对A组中出血较少的患者行预防性单侧弓形动脉缝扎；因B组合并宫体收缩乏力，对B组出血较多的患者行双侧弓形动脉缝扎止血，出血较少的行预防性双侧缝扎。如仍有出血倾向行其他手术方式。两组中因出血行弓形动脉缝扎的为出血组，行预防性缝扎的为预防组，统计A、B两组中出血组的手术时间、术中出血量、即刻止血率、有效率、术后24h出血量、术后病率、术后并发症及术后平均住院日。统计止血组及预防组的手术时间、术中出血量、术后24h出血量、术后病率、术后并发症及术后平均住院日。结果：1．其中29例为胎盘附着患侧宫角部位（包括9例胎盘粘连，1例合并副胎盘），6例为双胎妊娠，10例分娩巨大儿，5例既往有子宫手术史（1例子宫肌瘤核除术、4例剖宫产术），30例有流产史，1例为子宫畸形（双子宫），1例为妊娠合并子宫肌瘤，1例产程延长，3例患有妊娠期高血压疾病，8例为高龄产妇。 2．术中单侧宫角部收缩乏力24例（A组）及以宫角部收缩乏力为主同时伴有子宫体收缩乏力26例（B组）。A组有12例出血较多，B组有16例出血较多。A组及B组中的出血组经单（双）侧弓形动脉缝扎后，即刻止血率分别为100%（12/12）和87.5%（14/16），有效率为100%（12/12）和100%（16/16）。手术时间分别为（65±4）min和（72±5）min，术中出血量分别为（535±87）ml和（643±244）ml，预防组及出血组的手术时间分别为（59±7）min和（69±6）min，术中出血量分别为（212±19）ml和（596±198）ml。50例患者都达到了临床止血的目的，无1例切除子宫。 3．A组及B组中出血组术后24小时出血量分别为（130±13）ml和（130±23）ml，术后病率分别为8.3%（1/12）和6.2%（1/16），术后平均住院日分别为（5.4±0.5）天和（5.7±0.6）天。预防组及出血组术后24h出血量分别为（116±11）ml和（130±19）ml，术后病率分别为0（0/22）和7.1%（2/28），术后平均住院日分别为（5.0±0.3）天和（5.6±0.6）天，均无术后出血、肠梗阻等并发症。结论：1．剖宫产术中子宫角部收缩乏力的主要原因依次有胎盘附着宫角收缩不良、双胎妊娠和巨大儿、子宫手术史、子宫畸形、妊娠合并子宫肌瘤、高龄妊娠、妊娠期高血压疾病、产程延长和局部肌层发育不良等。 2．子宫角部收缩乏力采用单（双）侧子宫弓形动脉缝扎术不仅能预防剖宫产术后出血，且能有效的控制术中出血，具有操作简单、止血迅速、效果确切、无肠梗阻等术后并发症、不影响子宫及卵巢的血流及功能，，值得临床推广。
[Abstract]:Objective: to analyze the causes of uterine atony in cesarean section and to explore the curative effect of arcuate artery suture.
Methods: in the second O two hospital of the Chinese people's Liberation Army (PLA) from September 2013 to December 2013, a total of 50 cases of uterine atony in the caesarean section of the caesarean section were not effective during the caesarean section. The general situation of 50 patients was analyzed, including age, pregnancy, pregnancy, birth, birth, previous medical history, uterine surgery, complications of pregnancy and complications. According to the operation, there were 24 cases of unilateral uterine atony (A group), and the other 26 cases with unilateral uterine atony and uterine atony (B group). Patients with less bleeding in group A were treated with unilateral arcuate artery ligation in A group. Patients with more bleeding in group B were treated with bilateral arcuate artery suture and less bleeding. If there was still bleeding tendency, other surgical methods were performed. In the two groups, the bows were caused by bleeding. The prophylactic group was taken as the hemorrhage group and the preventive suture group was taken as the prevention group. The operation time, the amount of bleeding, the immediate hemostasis rate, the efficiency, the postoperative 24h bleeding, the postoperative morbidity, postoperative complications and the average hospitalization days after operation were statistically analyzed in the two groups of A and B groups. The operation time of the hemostasis group and the prevention group, the amount of bleeding during the operation, and the amount of 24h bleeding after the operation were counted. Postoperative morbidity, postoperative complications and postoperative hospital stay were compared.
Results: 1. of them, 29 were the part of the placental attachment, including 9 cases of placental adhesion, 1 cases of accessory placenta, 10 cases of twin pregnancy, 10 case of giant baby, 5 cases of uterus operation history (1 cases of uterine myomectomy, 4 caesarean section), 30 cases of abortion history, 1 cases of uterine malformation (double uterus), 1 cases of pregnancy combined uterine myoma, 1, 1. The duration of labor was prolonged, 3 cases had hypertensive disorder complicating pregnancy, and 8 cases were elderly women.
2. cases (group A) and 24 cases of unilateral uterine atony (group A) and 26 cases of uterine atony and uterine atony in group B (group B), there were more bleeding in group.A. In group B, there were 16 cases of hemorrhage more.A and B group, after single (double) side arcuate artery ligation, the rate of hemostasis was 100% (12/12) and 87.5% (14/16), respectively. The operation time was 100% (12/12) and 100% (16/16). The operation time was (65 + 4) min and (72 + 5) min respectively. The amount of bleeding in the operation was (535 + 87) ml and (643 + 244) ml respectively. The operation time of the prevention group and the bleeding group was (59 + 7) min and (69 + 6) min respectively. The intraoperative bleeding volume was respectively ml and ml.50 cases all achieved the purpose of clinical hemostasis. Excision of the uterus.
The bleeding volume in group 3.A and group B was (130 + 13) ml and (130 + 23) ml after operation, and the postoperative morbidity was 8.3% (1/12) and 6.2% (1/16) respectively. The average hospitalization days after operation were (5.4 + 0.5) days and (5.7 + 0.6) days respectively. The amount of 24h hemorrhage in the prevention and hemorrhage groups was (116 + 11) ml and (0/22) ml respectively. (2/28) the average postoperative hospital stay was (5 + 0.3) days and (5.6 + 0.6) days respectively. No postoperative bleeding, intestinal obstruction and other complications occurred.
Conclusion: 1. the main causes of uterine atony in caesarean section are poor placental attachment, double pregnancy and giant infants, uterus operation history, uterine malformation, pregnancy combined with hysteromyoma, elderly pregnancy, pregnancy induced hypertension, prolonged labor and muscular layer dysplasia.
2. a single (double) lateral uterine arcuate artery ligation can not only prevent the bleeding after cesarean section, but also effectively control the bleeding in the operation. It has simple operation, rapid hemostasis, accurate effect, no intestinal obstruction and other postoperative complications. It does not affect the blood flow and function of the uterus and the egg nest. It is worthy of clinical popularization.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R719.8

【参考文献】