徐秀英 刘伟武 叶雪梅 徐敏兰

[摘要] 目的 探讨子宫动脉结扎术在前置胎盘剖宫产术中的应用效果。 方法 选择2012年1月～2013年12月我院收治的因前置胎盘行剖宫产术的产妇56例。按照产妇具体情况、医生评估和家属意见将其分为对照组28例和实验组28例。实验组产妇术中行子宫动脉结扎术；对照组行常规止血。记录两组产妇术中出血量和术后恢复状况。 结果 实验组产妇手术时间、平均住院天数均显著短于对照组（P<0.05），术中出血量、术中输血例数、术后24 h内出血例数均显著少于对照组（P<0.05），产褥感染率低于对照组（P<0.05）。两组产妇产后恶露排除率、月经恢复率、月经周期正常率和母乳分泌情况比较，差异无统计学意义（P>0.05）。两组患者术后6、9个月和1年的FSH、LH、E2水平比较，差异无统计学意义（P>0.05）。 结论 前置胎盘剖宫产术中应用子宫动脉结扎术可有效减少术中出血量，缩短产后恢复时间。

[关键词] 子宫动脉结扎术；前置胎盘剖宫术；术中出血量

[中图分类号] R714.46+1 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0078-03

[Abstract] Objective To investigate the application effect of uterine artery ligation in the cesarean section for placenta previa. Methods 56 pregnant women who admitted in our hospital and received cesarean section for placenta previa from January 2012 to December 2013 were selected.The patients were divided into control group and experimental group with 28 cases in each group according to the condition of the pregnancy，doctor′s evaluation and families′ advices.Patients in experimental group were conducted uterine artery ligation while patients in control group received conventional hemostasis.The bleeding amount and postoperative recovery of patients between two groups were recorded. Results Patients in experimental group had significant shorter operation time，less bleeding amount，blood transfusion volume， bleeding volume within 24 hours after the operation，lower puerperal infection incidence and shorter average hospitalization time than that of control group（P<0.05）.The lochia excretion rate，normal rate of menstruation period and condition of milk secreation had no significant differences（P>0.05）.The FSH，LH and E2 level at 6 months，9 months and 1 year after the operation had no significant differences between two groups（P>0.05）. Conclusion The application of uterine artery ligation in cesarean section for placenta previa can effectively reduce the bleeding amount during the operation and shorten the recovery time.

[Key words] Uterine artery ligation；Cesarean section for placenta previa；Bleeding amount during the operation

正常胎盘附着于子宫体底部、后壁、前壁或侧壁，然而由于人工流产、引产、剖宫产等手术因素增加，妊娠期前置胎盘发生率也随之升高，其与正常胎盘的差异表现为：胎盘附着于子宫下段，甚至胎盘下缘达到或覆盖子宫内口。前置胎盘是妊娠晚期出血的常见原因之一，也是产后出血的高危因素[1]。产后出血起病急、进展快，是威胁产妇生命的急症之一[2-4]。产后出血传统治疗方法有宫腔填纱术、宫腔内“8”字缝合术、切除子宫等[5-7]。子宫切除能起到一定程度上的治疗效果，但使女性永远丧失了生育能力，给女性带来难以弥补的心理创伤[8]。前置胎盘孕妇绝大部分须选择剖宫产终止妊娠，临床剖宫产术中或术后大出血风险较大，是分娩期产妇较为常见的并发症之一，严重威胁母婴生命安全，选取恰当的止血方式，降低术中大出血风险是临床亟需解决的重要问题。本研……