协和医学杂志

2013, (02)

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B-lynch缝合术治疗及预防产后出血的临床效果
Effectiveness of B-lynch Suture in Treatment and Prevention of Postpartum Hemorrhage

高劲松;龚晓明;刘海元;刘俊涛;宋英娜;孙智晶;张颖

摘要(Abstract):

目的:初步评价B-lynch缝合术在治疗及预防产后出血中的有效性。方法:回顾性 分析北京协和医院2006年1月至2012年1月间施行B-lynch缝合术的20例患者的临床资料。 其中,19例为剖宫产分娩时发生产后出血,应用促宫缩剂无效后施行B-lynch缝合术,1例 为有促宫缩剂禁忌证的重症围产期心肌病患者为预防产后出血而行B-lynch缝合术。手术方 法按经典B-lynch缝合术进行。对患者缝合前后出血量、住院期间情况、产后 42 d复查情 况及远期月经情况、再次妊娠情况进行随访。结果:20例患者B-lynch缝合前出血量为 200~4800 ml,中位出血量为 900 ml;缝合后至产后 24 h出血量为50~200 ml,中位出血量 为 100 ml。17例患者单纯行B-lynch缝合后即达到较好的止血效果,3例出血严重患者在缝 合后出血有所减少,但仍加用了子宫动脉缝扎术和(或)子宫动脉栓塞术。所有患者术后及 产褥期复诊均恢复良好;远期随诊有2例月经量减少,1例继发不孕。结论:B-lynch缝合术 是一项简单可靠、并发症少的产后出血保守性手术治疗方法。
Objective:To evaluate the effectiveness of B-lynch suture in treatment and prevention of postpartum hemorrhage. Methods:The clinical data of 20 Cesarean section cases who were admitted to our department from January 2006 to January 2012 were retrospectively analyzed. B-lynch suture was placed in 19 patients due to postpartum hemorrhage and in 1 patient for preventing massive hemorrhage with oxytocin and prostaglandins contraindications. The effectiveness, uterine retracting, and other complications were investigated during the follow-up. Results:The amount of bleeding before and 24 hours after B-lynch suture were 200-4800 ml(median:900 ml) and 50-200 ml(median:100 ml),respectively. Good hemostatic effect was achieved in 17 patients immediately after the suture procedure. In 3 severe cases, the blood loss declined after the procedure, while other interventions including uterine artery ligation and/or embolization were also applied. All patients recovered well after surgery and during the postpartum follow-up. No specific complication was found. Conclusion:B-lynch suture is a simple and effective surgical technique that can be used to manage postpartum hemorrhage and avoidhysterectomy.

关键词(KeyWords): |B-lynch缝合术|产后出血|宫缩乏力|保守性手术|
|B-lynch suture|postpartum hemorrhage|uterine atony|conservative operation|

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作者(Author): 高劲松;龚晓明;刘海元;刘俊涛;宋英娜;孙智晶;张颖

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