摘要
目的:比较子宫单切口与子宫双切口在凶险性前置胎盘患者手术中的临床应用价值。方法:收集2016年12月至2018年12月于甘肃省妇幼保健院住院剖宫产手术分娩,根据术前超声检查评分诊断并在术中确诊为凶险性前置胎盘的孕妇共136例,根据术前、术中的评估,采用子宫下段单切口术式的94例(69.1%)为子宫单切口组、采用子宫双切口术式的42例(30.9%)为子宫双切口组。收集两组孕妇的年龄、孕次、剖宫产次数、术中出血量、术中输血量及手术时间、术后并发症及围产儿结局等资料,并进行比较分析。结果:子宫双切口组与子宫单切口组在前置胎盘严重程度、孕妇的年龄、孕次、流产次数、既往剖宫产次数、终止妊娠的孕周方面比较,差异均无统计学意义(P>0.05)。子宫单切口组与子宫双切口组孕妇的术中出血量分别为2852.74±1060.26 ml、1578.26±916.53 ml、输红细胞量分别为1549.56±986.36 ml、1052.35±589.69 ml、手术时间分别为125.30±36.63分钟、148.42±40.75分钟,差异均有统计学意义(P<0.05)。子宫切除子宫单切口组12例,双切口组3例,差异无统计学意义(χ~2=0.935,P=0.334)。子宫单切口组与子宫双切口组在术后凝血功能异常的发生、住院时及术后发热方面比较,差异均有统计学意义(P<0.05)。两组孕妇在膀胱损伤的发生、术后24小时出血、新生儿Agpar评分方面比较,差异无统计学意义(P>0.05)。结论:子宫双切口应用于凶险性前置胎盘剖宫产手术中,能够减少术中出血、保留子宫及降低术后凝血功能异常的发生。
Objective:To evaluate the clinical value of uterine single and double incisions in the operation of pernicious placenta previa.Methods:136 cases were initially diagnosed pernicious placenta previa by ultrasonography and confirmed by intraoperative findings from December 2016 to December 2018.The patients were divided into two groups according to surgical approaches.Age,gravidity,history of cesarean section,intraoperative blood lossand blood transfusion,duration of operation,complications and perinatal outcomes were analyzed.Results:Single uterine incision were used in 94 patients(69.1%) while double uterine incision in 42 patients(30.9%).Intraoperative blood loss was 2852.74±1060.26 ml in single-incision group while 1578.26±916.53 ml in double-incision group,intraoperative blood transfusion was 1549.56±986.36 ml in single-incision group and 1052.35±589.69 ml in double-incision group,duration of operation was 125.30±36.63 min in single-incision group and 148.42±40.75 min in double-incision group.There were significant differences between two groups(P<0.05).There was no statistical difference between two groups in hysterectomy(χ~2=0.935,P=0.334).Coagulation dysfunction and fever after operation,duration of hospitalization between two groups were significantly different(P<0.05).There was no significant difference in bladder injury,24-hour bleeding and Agpar score between two groups(P>0.05).Conclusions:Used in operation of pernicious placenta previa,double uterine incision can reduce the incidence of postpartum hemorrhage and postoperative coagulation dysfunction,and can be helpful in retaining uterus.
作者
刘小晖
董燕
刘小玲
张玉芳
高丽娜
何晓春
LIU Xiaohui;DONG Yan;LIU Xiaoling(Gansu Provincial Maternity and Child Care Hospital Obstetrics UnitU,Lanzhou Gansu 730050,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2020年第3期223-226,共4页
Journal of Practical Obstetrics and Gynecology
关键词
子宫单切口
子宫双切口
凶险性前置胎盘
出血
Uterine single incision
Uterine double incision
Pernicious placenta previa
Hemorrhage
