难治性产后出血5种止血手术疗效比较及止血失败原因分析.docVIP

难治性产后出血5种止血手术疗效比较及止血失败原因分析 　　[摘要] 目的 探讨5种止血手术治疗难治性产后出血的临床效果，并分析止血失败的原因。 方法 选取我院2010年1月～2013年12月收治的180例难治性产后出血患者作为研究对象，依据不同止血方法进行分组，子宫腔填塞术60例，子宫背带式捆绑术36例，子宫压迫缝合术24例，子宫动脉上+下行支结扎术24例，盆腔动脉栓塞术36例。观察其止血效果和止血失败的原因。 结果 盆腔动脉栓塞术的手术时间明显短于其他4种手术，术中出血量明显少于其他4种手术，差异有统计学意义（P0.05）；24例止血失败，主要原因是瘢痕子宫、胎盘植入、凝血功能障碍，比例分别为50.0%、25.0%、25.0%。 结论 5种止血手术在难治性产后出血治疗中均是可行的，尤其盆腔动脉栓塞术手术时间短、出血量少。同时，瘢痕子宫、胎盘植入、凝血功能障碍均是止血失败的原因，应依据孕妇情况合理选择止血方法。 　　[关键词] 难治性产后出血；止血手术；失败原因 　　[中图分类号] R714.46+1 [文献标识码] A [文章编号] 1674-4721（2016）01（b）-0056-03 　　Curative effect comparison of five kinds of hemostatic operation on intractable postpartum hemorrhage and reason analysis of hemostasis failure 　　WANG Lin 　　Department of Gynecology and Obstetrics，Zhengzhou TCM Hospital，Zhengzhou 450000，China 　　[Abstract] Objective To explore the clinical effect of five kinds of hemostatic operation treating intractable postpartum hemorrhage，and analyze the cause of hemostasis failure. Methods From January 2010 to December 2013，180 patients suffering from intractable postpartum hemorrhage in our hospital were selected as research group.According to different hemostatic methods，they were divided into uterine cavity packing （n=60），strap-uterine binding （n=36），uterine compression suture （n=24），ascending and descending branches of uterine artery ligation （n=24），pelvic arterial embolization （n=36）.The hemostatic effect and cause of failure was observed respectively. Results The operation time in pelvic arterial embolization was obviously shorter than that of other four kinds of method，amount of bleeding during surgery in pelvic arterial embolization was greatly less than that of other four kinds of method，which displayed a statistical difference （P0.05）.There were 24 cases for hemostasis failure，mainly due to scarred uterus，placenta implantation，and coagulation dysfunction，and it accounted for 50.0%，25.0%，and 25.0% respectively. Conclusion Five other four kinds of method on intractable postpartum hemorrhage is feasible，especially pel