子宫动脉结扎联合B-Lynch缝合术后并发子宫坏死3例并文献复习
摘要
目的:探讨子宫动脉结扎联合B-Lynch缝合术治疗难治性产后出血(PPH)致子宫坏死的形成原因、诊断、治疗及预防对策。方法:回顾分析郑州大学附属郑州中心医院收治的3例因难治性PPH而行子宫动脉结扎联合B-Lynch缝合术致子宫坏死的临床资料,并结合国内外文献进行分析。结果:3例PPH患者均先经宫缩剂、持续性子宫按摩或按压等保守治疗,效果较差,遂予行双侧子宫动脉结扎+B-Lynch缝合术。术后第2天,患者开始出现不同程度间断体温升高,给予抗感染、宫腔引流等对症治疗,治疗效果较差。3例患者分别于术后第21、17、47天行剖腹探查术,后行子宫切除术。术后病理结果回示符合子宫坏死诊断。3例术后均恢复良好,经随访20～24个月,未诉不适。结论:B-Lynch缝合术及子宫动脉结扎术是目前治疗难治性PPH的常用手术方式,实施前应严格掌握手术适应证及熟练操作流程,两者联合应用时有增加子宫坏死的可能性。
引文
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[19]唐俐,杨敏,王秀琴.子宫压迫缝合致子宫肌层坏死3例报道[J].现代妇产科进展,2018,27(4):287-289
[20]Treloar EJ,Anderson RS,Andrews HS,et al.Uterine necrosis following B-Lynch suture for primary postpartum haemorrhage[J].BJOG,2006,113(4):486-488
[2]Sentilhes L,Merlot B,Madar H,et al.Postpartum haemorrhage:prevention and treatment[J].Expert Rev Hematol,2016,9(11):1043-1061
[3]Vijayasree M.Efficacy of prophylactic B-Lynch suture during lower segment caesarian section in high risk patients for atonic postpartum haemorrhage[J].Kathmandu Univ Med J,2016,14(53):9-12
[4]Gezgin K,Yazici F,Koyuncu T,et al.Bilateral uterine and ovarian artery ligation in addition to B-lynch suture may be an alternative to hysterectomy for uterine atonic hemorrhage[J].Clin Exp Obstet Gynecol,2012,39(2):168-170
[5]Shahin AY,Farghaly TA,Mohamed SA,et al.Bilateral uterine artery ligation plus B-Lynch procedure for atonic postpartum hemorrhage with placenta accreta[J].Int J Gynaecol Obstet,2010,108(3):187-190
[6]Cekmez Y,Ozkaya E,Ocal FD,et al.Experience with different techniques for the management of postpartum hemorrhage due to uterine atony:compression sutures,artery ligation and Bakri balloon[J].Ir J Med Sci,2015,184(2):399-402
[7]Kaoiean S.Successful use of the B-Lynch uterine compression suture in treating intractable postpartum hemorrhage after cesarean delivery in Rajavithi Hospital[J].J Med Assoc Thai,2013,96(11):1408-1415
[8]中华医学会妇产科学分会产科学组.产后出血预防与处理指南(2014)[J].中华妇产科杂志,2014,49(9):641-646
[9]Haumonte JB,Sentilhes L,Mace P,et al.Surgical treatment of postpartum hemorrhage[J].J Gynecol Obstet Biol Reprod,2014,43(10):1083-1103
[10]B-Lynch C,Coker A,Lawal AH,et al.The B-Lynch surgical technique for the control of massive postpartum haemorrhage:an alternative to hysterectomy?Five cases reported[J].Br J Obstet Gynaecol,1997,104(3):372-375
[11]Matsubara S,Yano H,Ohkuchi A,et al.Uterine compression sutures for postpartum hemorrhage:an overview[J].Acta Obstet Gynecol Scand,2013,92(4):378-385
[12]Cho JH,Jun HS,Lee CN.Hemostatic suturing technique for uterine bleeding during cesarean delivery[J].Obstet Gynecol,2000,96(1):129-131
[13]Hayman RG,Arulkumaran S,Steer PJ.Uterine compression sutures:surgical management of postpartum hemorrhage[J].Obstet Gynecol,2002,99(3):502-506
[14]Joshi VM,Shrivastava M.Partial ischemic necrosis of the uterus following a uterine brace compression suture[J].BJOG,2004,111(3):279-280
[15]B-Lynch C.Partial ischemic necrosis of the uterus following a uterine brace compression suture[J].BJOG,2005,112(1):126-127
[16]El-Hamamy E,Wright A,B-Lynch C.The B-Lynch suture technique for postpartum haemorrhage:a decade of experience and outcome[J].J Obstet Gynaecol,2009,29(4):278-283
[17]Price N,B-Lynch C.Technical description of the B-Lynch brace suture for treatment of massive postpartum hemorrhage and review of published cases[J].Int J Fertil Womens Med,2005,50(4):148-163
[18]El-Hamamy E,B-Lynch C.A worldwide review of the uses of the uterine compression suture techniques as alternative to hysterectomy in the management of severe postpartum haemorrhage[J].J Obstet Gynaecol,2005,25(2):143-149
[19]唐俐,杨敏,王秀琴.子宫压迫缝合致子宫肌层坏死3例报道[J].现代妇产科进展,2018,27(4):287-289
[20]Treloar EJ,Anderson RS,Andrews HS,et al.Uterine necrosis following B-Lynch suture for primary postpartum haemorrhage[J].BJOG,2006,113(4):486-488