标题：早期结扎双侧子宫动脉上行支在凶险性前置胎盘剖宫产术救治中的应用价值

      作者：江丽瑜，林少敏，李展纯    揭阳市慈云医院妇产科，广东 揭阳 522031

      卷次： 2019年30卷10期

      【摘要】 目的 探讨凶险性前置胎盘剖宫产术中应用早期结扎双侧子宫动脉上行支(BUAS)的临床效果。方法 选取2016年3月至2018年2月揭阳市慈云医院妇产科收治的凶险性前置胎盘孕妇62例为研究对象，根据随机数表法分为观察组和对照组，每组31例，对照组孕妇给予传统剖宫产术处理，观察组孕妇在剖宫产术中应用早期结扎BUAS治疗，比较两组产妇的手术相关指标及术中处理情况,并随访两组产妇6个月后的月经量减少、宫腔黏连及卵巢功能状态[黄体生成激素(LH)、促卵泡成熟激素(FSH)、雌二醇 (E2)]。结果 观察组与对照组产妇手术时间分别为(51.29±12.37) min和(67.42±13.58) min，术中出血量分别为(521.67±103.87) mL和(804.98±218.22) mL，手术结束后 24 h出血量分别为(57.41±3.29) mL和(64.09±5.12) mL，观察组均优于对照组，差异均有统计学意义(P<0.05)；观察组产妇的子宫切除率为25.81%，明显低于对照组的64.52%，术中输血率为25.81%，明显低于对照组的70.97%，差异均有统计学意义(P<0.05)；观察组和对照组产妇的子宫动脉结扎率分别为90.32%和100.00%，差异无统计学意义(P>0.05)；术后随访6个月，观察组和对照组患者E2 [(61.33±12.26) pmol/mL vs (74.27±13.58) pmol/mL]、FSH [(7.67±2.41) IU/L vs (8.98±2.22) IU/L]、LH [(5.39±1.38) IU/L vs (6.21±1.22) IU/L]比较，观察组均优于对照组，差异均有统计学意义(P<0.05)；观察组和对照组患者月经量减少率(0 vs 16.13%)和宫腔黏连发生率(3.23% vs 19.35%)比较，观察组均明显低于对照组，差异均有统计学意义(P<0.05)。结论 凶险性前置胎盘剖宫产术中应用早期结扎BUAS可有效降低术中出血量，降低子宫切除率，有利于术后产妇卵巢功能恢复，疗效显著，值得临床推广。
      【关键词】 凶险性前置胎盘；前置胎盘；剖宫产术；双侧子宫动脉上行支；结扎；子宫动脉
      【中图分类号】 R719.8 【文献标识码】 A 【文章编号】 1003—6350（2019）10—1300—03

Application value of early ligation of bilateral ascending uterine artery in the treatment of dangerous placentaprevia during cesarean section.
JIANG Li-yu, LIN Shao-min, LI Zhan-chun. Department of Obstetrics and Gynecology,Ciyun Hospital of Jieyang City, Jieyang 522031, Guangdong, CHINA
【Abstract】 Objective To investigate the effect of early ligation of bilateral uterine artery ascending (BUAS) incaesarean section of dangerous placenta previa. Methods A total of 62 pregnant women with dangerous placenta pre-via, who admitted to Department of Obstetrics and Gynecology of Ciyun Hospital of Jieyang City from March 2016 toFebruary 2018, were selected and divided into the observation group and control group according to random number ta-ble method, with 31 cases in each group. The pregnant women in the control group were treated with traditional cesareansection, and the pregnant women in the observation group were treated with early ligation of BUAS during cesarean sec-tion. The operation-related indicators and intraoperative management of the two groups were compared, and the menstru-al volume reduction, intrauterine adhesions and ovarian function status (luteinizing hormone [LH], follicle stimulatinghormone [FSH], estradiol [E2]) were followed up for 6 months. Results The operation time of the observation groupand the control group were (51.29±12.37) min and (67.42±13.58) min, the intraoperative bleeding volume were (521.67±103.87) mL and (804.98±218.22) mL, and the bleeding volume at 24 hours after operation were (57.41±3.29) mL and(64.09±5.12) mL respectively. The observation group was superior to the control group, and the differences were statisti-cally significant (P<0.05). Hysterectomy rate and intraoperative blood transfusion rate of the observation group were