本文選題：剖宮產(chǎn)術(shù) + 宮縮乏力��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：分析剖宮產(chǎn)術(shù)中發(fā)生子宮角部收縮乏力的原因，并探討行弓形動(dòng)脈縫扎術(shù)治療的療效。 方法：收集中國人民解放軍第二O二醫(yī)院2013年9月至2013年12月期間，剖宮產(chǎn)術(shù)中發(fā)生經(jīng)保守治療無效的宮角部收縮乏力的病例，總共50例，分析50例患者的一般情況，包括年齡、孕周、孕次、產(chǎn)次、既往病史、子宮手術(shù)史、妊娠期合并癥及并發(fā)癥、新生兒體重及術(shù)中情況，探討發(fā)生宮角部收縮乏力的原因。根據(jù)術(shù)中所見，有24例為單側(cè)宮角部收縮乏力（簡稱A組），另26例為以單側(cè)宮角部收縮乏力為主同時(shí)伴有子宮體收縮乏力（簡稱B組）。對(duì)A組中宮角部收縮乏力性出血較多的患者行單側(cè)弓形動(dòng)脈縫扎止血，對(duì)A組中出血較少的患者行預(yù)防性單側(cè)弓形動(dòng)脈縫扎；因B組合并宮體收縮乏力，對(duì)B組出血較多的患者行雙側(cè)弓形動(dòng)脈縫扎止血，出血較少的行預(yù)防性雙側(cè)縫扎。如仍有出血傾向行其他手術(shù)方式。兩組中因出血行弓形動(dòng)脈縫扎的為出血組，行預(yù)防性縫扎的為預(yù)防組，統(tǒng)計(jì)A、B兩組中出血組的手術(shù)時(shí)間、術(shù)中出血量、即刻止血率、有效率、術(shù)后24h出血量、術(shù)后病率、術(shù)后并發(fā)癥及術(shù)后平均住院日。統(tǒng)計(jì)止血組及預(yù)防組的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后24h出血量、術(shù)后病率、術(shù)后并發(fā)癥及術(shù)后平均住院日。 結(jié)果：1．其中29例為胎盤附著患側(cè)宮角部位（包括9例胎盤粘連，1例合并副胎盤），6例為雙胎妊娠，10例分娩巨大兒，5例既往有子宮手術(shù)史（1例子宮肌瘤核除術(shù)、4例剖宮產(chǎn)術(shù)），30例有流產(chǎn)史，1例為子宮畸形（雙子宮），1例為妊娠合并子宮肌瘤，1例產(chǎn)程延長，3例患有妊娠期高血壓疾病，8例為高齡產(chǎn)婦。 2．術(shù)中單側(cè)宮角部收縮乏力24例（A組）及以宮角部收縮乏力為主同時(shí)伴有子宮體收縮乏力26例（B組）。A組有12例出血較多，B組有16例出血較多。A組及B組中的出血組經(jīng)單（雙）側(cè)弓形動(dòng)脈縫扎后，即刻止血率分別為100%（12/12）和87.5%（14/16），有效率為100%（12/12）和100%（16/16）。手術(shù)時(shí)間分別為（65±4）min和（72±5）min，術(shù)中出血量分別為（535±87）ml和（643±244）ml，預(yù)防組及出血組的手術(shù)時(shí)間分別為（59±7）min和（69±6）min，術(shù)中出血量分別為（212±19）ml和（596±198）ml。50例患者都達(dá)到了臨床止血的目的，無1例切除子宮。 3．A組及B組中出血組術(shù)后24小時(shí)出血量分別為（130±13）ml和（130±23）ml，術(shù)后病率分別為8.3%（1/12）和6.2%（1/16），術(shù)后平均住院日分別為（5.4±0.5）天和（5.7±0.6）天。預(yù)防組及出血組術(shù)后24h出血量分別為（116±11）ml和（130±19）ml，術(shù)后病率分別為0（0/22）和7.1%（2/28），術(shù)后平均住院日分別為（5.0±0.3）天和（5.6±0.6）天，均無術(shù)后出血、腸梗阻等并發(fā)癥。 結(jié)論：1．剖宮產(chǎn)術(shù)中子宮角部收縮乏力的主要原因依次有胎盤附著宮角收縮不良、雙胎妊娠和巨大兒、子宮手術(shù)史、子宮畸形、妊娠合并子宮肌瘤、高齡妊娠、妊娠期高血壓疾病、產(chǎn)程延長和局部肌層發(fā)育不良等。 2．子宮角部收縮乏力采用單（雙）側(cè)子宮弓形動(dòng)脈縫扎術(shù)不僅能預(yù)防剖宮產(chǎn)術(shù)后出血，且能有效的控制術(shù)中出血，具有操作簡單、止血迅速、效果確切、無腸梗阻等術(shù)后并發(fā)癥、不影響子宮及卵巢的血流及功能，，值得臨床推廣。
[Abstract]:Objective: to analyze the causes of uterine atony in cesarean section and to explore the curative effect of arcuate artery suture.
Methods: in the second O two hospital of the Chinese people's Liberation Army (PLA) from September 2013 to December 2013, a total of 50 cases of uterine atony in the caesarean section of the caesarean section were not effective during the caesarean section. The general situation of 50 patients was analyzed, including age, pregnancy, pregnancy, birth, birth, previous medical history, uterine surgery, complications of pregnancy and complications. According to the operation, there were 24 cases of unilateral uterine atony (A group), and the other 26 cases with unilateral uterine atony and uterine atony (B group). Patients with less bleeding in group A were treated with unilateral arcuate artery ligation in A group. Patients with more bleeding in group B were treated with bilateral arcuate artery suture and less bleeding. If there was still bleeding tendency, other surgical methods were performed. In the two groups, the bows were caused by bleeding. The prophylactic group was taken as the hemorrhage group and the preventive suture group was taken as the prevention group. The operation time, the amount of bleeding, the immediate hemostasis rate, the efficiency, the postoperative 24h bleeding, the postoperative morbidity, postoperative complications and the average hospitalization days after operation were statistically analyzed in the two groups of A and B groups. The operation time of the hemostasis group and the prevention group, the amount of bleeding during the operation, and the amount of 24h bleeding after the operation were counted. Postoperative morbidity, postoperative complications and postoperative hospital stay were compared.
Results: 1. of them, 29 were the part of the placental attachment, including 9 cases of placental adhesion, 1 cases of accessory placenta, 10 cases of twin pregnancy, 10 case of giant baby, 5 cases of uterus operation history (1 cases of uterine myomectomy, 4 caesarean section), 30 cases of abortion history, 1 cases of uterine malformation (double uterus), 1 cases of pregnancy combined uterine myoma, 1, 1. The duration of labor was prolonged, 3 cases had hypertensive disorder complicating pregnancy, and 8 cases were elderly women.
2. cases (group A) and 24 cases of unilateral uterine atony (group A) and 26 cases of uterine atony and uterine atony in group B (group B), there were more bleeding in group.A. In group B, there were 16 cases of hemorrhage more.A and B group, after single (double) side arcuate artery ligation, the rate of hemostasis was 100% (12/12) and 87.5% (14/16), respectively. The operation time was 100% (12/12) and 100% (16/16). The operation time was (65 + 4) min and (72 + 5) min respectively. The amount of bleeding in the operation was (535 + 87) ml and (643 + 244) ml respectively. The operation time of the prevention group and the bleeding group was (59 + 7) min and (69 + 6) min respectively. The intraoperative bleeding volume was respectively ml and ml.50 cases all achieved the purpose of clinical hemostasis. Excision of the uterus.
The bleeding volume in group 3.A and group B was (130 + 13) ml and (130 + 23) ml after operation, and the postoperative morbidity was 8.3% (1/12) and 6.2% (1/16) respectively. The average hospitalization days after operation were (5.4 + 0.5) days and (5.7 + 0.6) days respectively. The amount of 24h hemorrhage in the prevention and hemorrhage groups was (116 + 11) ml and (0/22) ml respectively. (2/28) the average postoperative hospital stay was (5 + 0.3) days and (5.6 + 0.6) days respectively. No postoperative bleeding, intestinal obstruction and other complications occurred.
Conclusion: 1. the main causes of uterine atony in caesarean section are poor placental attachment, double pregnancy and giant infants, uterus operation history, uterine malformation, pregnancy combined with hysteromyoma, elderly pregnancy, pregnancy induced hypertension, prolonged labor and muscular layer dysplasia.
2. a single (double) lateral uterine arcuate artery ligation can not only prevent the bleeding after cesarean section, but also effectively control the bleeding in the operation. It has simple operation, rapid hemostasis, accurate effect, no intestinal obstruction and other postoperative complications. It does not affect the blood flow and function of the uterus and the egg nest. It is worthy of clinical popularization.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R719.8

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