晨笛网压缝合术在5例难治性产后出血患者中的初步应用

发布时间：2018-07-15 23:05

【摘要】：目的探讨晨笛网压缝合术(CNCS)在难治性产后出血(PPH)治疗中的应用价值。方法回顾性分析5例难治性PPH患者实施CNCS的临床资料,评价手术疗效及安全性。结果 5例患者行CNCS后,子宫活动性出血5~10 min停止,观察30 min阴道无明显流血后关腹,均成功保留子宫。术后5 d患者垂体激素、甲状腺激素、肾上腺激素及女性激素均在正常范围。术后4 d MRI显示,宫壁见散在点状信号,未见宫腔积液;术后46 d MRI显示,宫壁肌层信号均匀,宫内膜线清晰。术后42 d超声检查显示,子宫前后径3.5~4.5 cm,宫壁肌层回声均匀,复旧形态良好。术后5个月宫腔镜显示,宫腔无粘连,内膜形态正常,输卵管开口清晰。术后随访1例患者在哺乳期,其余患者停止哺乳后1~2个月月经恢复正常;1例患者术后20个月再次妊娠,术后29个月经剖宫产产一健康女婴。结论 CNCS在难治性PPH的治疗中有重要应用价值。在实施子宫按摩、促宫缩药物注射、宫腔纱条填塞、子宫动脉结扎及B-Lynch缝合等治疗后,仍无法止血的乏力性PPH患者,应果断选择CNCS进行急救。
[Abstract]:Objective to evaluate the clinical value of morning flute net suture (CNCS) in the treatment of refractory postpartum hemorrhage (PPH). Methods the clinical data of 5 patients with refractory PPH undergoing CNCS were retrospectively analyzed to evaluate the efficacy and safety of the operation. Results after CNCS was performed in 5 patients, the uterine active bleeding stopped for 5 to 10 min. After 30 min of vaginal bleeding, the abdomen was closed, and the uterus was preserved successfully. Pituitary hormone, thyroid hormone, adrenal hormone and female hormone were in normal range 5 days after operation. On the 4th day after operation, focal signal was observed in the wall of the uterus, and no effusion was found in the uterine cavity, and on 46 days after operation, the signal intensity of the myometrium of the uterine wall was homogeneous and the line of the uterine intima was clear. Ultrasound examination 42 days after operation showed that the uterine diameter was 3.5 ~ 4.5 cm, the myometrium echo was homogeneous and the shape of uterine wall was good. After 5 months, hysteroscopy showed that there was no adhesion in uterine cavity, the shape of endometrium was normal, and the opening of fallopian tube was clear. One patient was followed up during lactation, the rest patients resumed normal menstruation 1 ~ 2 months after stopping lactation, 1 patient was pregnant again 20 months after operation, 29 cases were pregnant by cesarean section after operation. Conclusion CNCS plays an important role in the treatment of refractory PPH. After the treatment of uterine massage, intrauterine drug injection, uterine gauze packing, uterine artery ligation and B-Lynch suture, the patients with anemic PPH still unable to stop bleeding should be treated with CNCS.
【作者单位】：四川省成都市第五人民医院妇产科;四川省成都市妇女儿童中心医院产前诊断科;四川省成都市第五人民医院放射科核磁室;四川省成都市温江区妇幼保健院妇产科;四川省崇州市妇幼保健院妇产科;四川省大邑县人民医院妇产科;
【基金】：四川省卫生和计划生育委员会科研课题(No:150023) 成都市科学技术局成都市科技惠民技术研发项目(No:2014-HM01-00330-SF) 成都市卫生局科研重大攻关项目(No:2014044)
【分类号】：R714.461

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