产后出血的保守性手术治疗

摘要/Abstract

摘要：

产后出血是分娩期常见而且严重的并发症，在药物和子宫按摩不能控制出血时，需采取手术干预。保守性手术是指保留子宫的手术方法，包括血管结扎、宫腔填塞压迫止血、子宫压迫缝合等。B-Lynch缝合技术在产后出血的保守性手术治疗中具有里程碑式的意义，并且由此改良出多种子宫压迫缝合方法。这些技术各有利弊和不同的适应证，根据产后出血的不同原因选择合适的保守性手术方式，才能达到良好止血和减少并发症的目的。

关键词: 产后出血, 动脉结扎, 子宫压迫缝合

Abstract:

Abstract：Postpartum hemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. When PPH is unresponsive to medication or uterine massage, conservative surgical intervention（uterine reserved） is necessary.These surgical interventions include arterial ligation, intrauterine tamponade techniques and uterine compression suture (such as Cho suture and B-Lynch which is a milestone in the conservative surgical treatment of PPH).However each technique has both merits and drawbacks,obstetricians must be aware of the cause of the PPH and the indication of various technique.

Key words: postpartum hemorrhage (PPH), arterial ligation, uterine compression suture

中图分类号:

R714.46+1

丁建，连岩，王谢桐. 产后出血的保守性手术治疗[J]. 中国实用妇科与产科杂志.

DING Jian*,LIAN Yan*,WANG Xie-tong. Conservative surgical management of postpartum hemorrhage.[J]. Acta Metallurgica Sinica.

参考文献



[1］ O’Leary JA.Uterine artery ligation in the control of postcesarean hemorrhage［J］. J Reprod Med,1995，40:189-193.

[2］ Bakri YN, Amri A, Abdul Jabbar F,et al.Tamponade-balloon for obstetrical bleeding［J］. Int J Gynaecol Obstet, 2001,74(2):139-142.

[3］ Gronvall M,Tikkanen M,Tallberg E,et al. Use of Bakri Balloon Tamponade in the treatment of postpartum hemorrhage:a series of 50 cases from a tertiary teaching hospital［J］. Acta Obstet Gynecol Scand,2013, 92(4):433-438.

[4］ Pinar K, Oya D, Emre E,et al. The Bakri balloon for the management of postpartum hemorrhage in cases with placenta previa［J］. European Journal of Obstetrics & Gynecology and Reproductive Biology,2013,167:167-170.

[5］ 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, 1997,104:372-375.

[6］ Kumara YVAL, Marasinghe JP, Condous G,et al. Pregnancy complicated by a uterine fundal defect resulting from a previous B-Lynch suture［J］. BJOG,2009, 116:1815-1817.

[7］ Fotopoulou C,Dudenhausen JW. Uterine compression sutures for preserving fertility in severe postpartum haemorrhage:an overview 13 years after the first description［J］. J Obstet Gynaecol, 2010,30(4):339-349.

[8］ 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 .

[9］ Hayman RG, Arulkumaran S, Steer PJ,et al. Uterine compression sutures:surgical management of postpartum hemorrhage［J］. Obstet Gynecol,2002,99:502-506.

[10］ Ghezzi F, Cromi A, Uccella S, et al. The Hayman technique:a simple method to treat postpartum haemorrhage［J］. Obstet Gynaecol,2007,114(3):362-365. 

[11］ Cho JH,Jun HS,Lee CN,et al.Hemostatic suturing technique for uterine bleeding during cesarean delivery［J］. Obstet Gynecol,2000,96(1):129-131.

[12］ Akoury H, Sherman C. Uterine wall partial thickness necrosis following combined B-Lynch and Cho square sutures for the treatment of primary postpartum hemorrhage［J］. J Obstet Gynaecol Can, 2008,30(5):421-414.

[13］ Reyftmann L,Nguyen A,Ristic V,et al. Partial uterine wall necrosis following Cho hemostatic sutures for the treatment of postpartum hemorrhage［J］. Gynecol Obstet Fertil,2009,37(6):579-582.

[14］ Ouahba J, Piketty M, Huel C, et al. Uterine compression sutures for postpartum bleeding with atony［J］. BJOG,2007,114(5):619-622.

[15］ Hwu YM, Chen CP, Chen HS,et al.Parallel vertical compression sutures:a technique to control bleeding from placenta praevia or accreta during caesarean section［J］. BJOG, 2005,112:1420-1423.

[16］ Zheng J, Xiong X, Ma Q, et al. A new uterine compression suture for postpartum hemorrhage with atony［J］. BJOG,2011,118:370-374.

[17］ Mostfa AA, Zaitoun MM. Study safety pin suture for management of atonic postpartum hemorrhage［J］ .ISRN Obstetrics and Gynecology, 2012,2012:405795. 

[18］ Nelson WL, O'Brien JM.The uterine sandwich for persistent uterine atony:combining the B-Lynch compression suture and an intrauterine Bakri balloon［J］. Am J Obstet Gynecol,2007, 196(5):9-10.

[19］ Zgur A,Aytul CE. Single square hemostatic suture for postpartum hemorrhage secondary to uterine atony［J］.Arch Gynecol Obstet,2013, 287:25-29.

[1]	刘燕燕, 冯玲. 阴道分娩宫缩乏力性产后出血的早期识别及处理[J]. 中国实用妇科与产科杂志, 2022, 38(8): 773-776.
[2]	陈璐, 周微笑, 贺晶. 软产道裂伤致隐匿性产后出血的早期识别及处理[J]. 中国实用妇科与产科杂志, 2022, 38(8): 784-787.
[3]	张国华, 沈雪艳, 崔文华. 继发性子宫收缩乏力出血病因查找、联合处置及弥散性血管内凝血防控[J]. 中国实用妇科与产科杂志, 2022, 38(2): 161-164.
[4]	张雪梅，漆洪波. 产后出血子宫切除对生活质量的影响[J]. 中国实用妇科与产科杂志, 2021, 37(2): 156-159.
[5]	赵扬玉，姜海. 妊娠及产后血栓性微血管病[J]. 中国实用妇科与产科杂志, 2021, 37(2): 189-192.
[6]	陈鹏, 刘兴会. 产后出血的预测和预警[J]. 中国实用妇科与产科杂志, 2021, 37(11): 1101-1105.
[7]	杨孜. 原发子宫收缩乏力产后出血预防行动的基点和预警[J]. 中国实用妇科与产科杂志, 2020, 36(8): 679-684.
[8]	刘兴会，何镭. 产后出血的预防和处理[J]. 中国实用妇科与产科杂志, 2020, 36(2): 123-126.
[9]	杨孜，段华. 卡前列甲酯临床应用专家共识（2020年版）[J]. 中国实用妇科与产科杂志, 2020, 36(11): 1091-1097.
[10]	中华医学会围产医学分会. 晚期产后出血诊治专家共识[J]. 中国实用妇科与产科杂志, 2019, 35(9): 1008-1013.
[11]	杨怡珂，漆洪波. 产后出血风险管理[J]. 中国实用妇科与产科杂志, 2019, 35(9): 978-982.
[12]	林建华. 妊娠合并结构异常性心脏病并发产后出血MDT管理专家共识[J]. 中国实用妇科与产科杂志, 2019, 35(5): 528-535.
[13]	尹宗智. 剖宫产手术中并发产后出血保守治疗[J]. 中国实用妇科与产科杂志, 2019, 35(2): 156-162.
[14]	陈春林，李兵. 血管内介入技术在产后出血防治中的应用专家共识（2019）[J]. 中国实用妇科与产科杂志, 2019, 35(12): 1333-1339.
[15]	陈敦金，贺芳. 中国孕产妇死亡率极大程度降低——对世界的最大贡献[J]. 中国实用妇科与产科杂志, 2019, 35(10): 1076-1080.