Sapmaz Ekrem, Celik Hüsnü, Altungül Aygen
Department of Obstetrics and Gynecology, Faculty of Medicine, Firat University, Elazig, Turkey.
J Reprod Med. 2003 Dec;48(12):950-4.
To comparatively investigate the effects of using bilateral ascending uterine artery ligation and tourniquet use on intraoperative and postoperative blood loss during myomectomy in cesarean cases.
A total of 70 pregnant women diagnosed with myomas in the prenatal period were included in this randomized, prospective study. They were admitted to our department during the study period. Fifty-two patients who underwent cesarean myomectomy were randomly divided into 2 equal groups. In the first group bilateral ascending uterine artery ligation and myomectomy were performed after lower uterine segment transverse cesarean section. The second group served as the control group; myomectomy was performed with a tourniquet. For statistical analysis, Mann Whitney U, chi 2 and Wilcoxon Rank tests were used. Spearman correlation analysis (rs, n, p) was used for analysis of correlation between the duration of the myomectomy operation and blood loss and number of enucleated myoma nuclei during myomectomy.
Total intraoperative blood loss, total operation duration, number of enucleated myoma nuclei (Mann Whitney U test) and febrile morbidity (chi 2 test) were similar in the 2 groups (P > .05). A significant positive correlation was established between the duration of the myomectomy operation and loss of blood and number of enucleated myoma nuclei during myomectomy (rs = .9, n = 52, P = .000). Urgent laparotomy and bilateral internal iliac artery ligation had to be performed in 1 patient in the tourniquet group who had a postoperative hemorrhage.
Despite the fact that bilateral ascending uterine artery ligation and tourniquet use had similar outcomes with regard to intraoperative blood loss in cesarean myomectomy cases, the efficacy of ligation on blood loss in the postoperative period continues owing to its permanence. The tourniquet method is not effective in the postoperative period since the tourniquet is removed at the end of the operation. Therefore, bilateral ascending uterine artery ligation may be preferable in cesarean myomectomy cases.
比较双侧子宫动脉上行支结扎术与使用止血带对剖宫产子宫肌瘤剔除术中及术后失血的影响。
本随机前瞻性研究纳入了70例孕期诊断为子宫肌瘤的孕妇。她们在研究期间入住我科。52例行剖宫产子宫肌瘤剔除术的患者被随机分为两组，每组人数相等。第一组在子宫下段横切口剖宫产术后行双侧子宫动脉上行支结扎术及子宫肌瘤剔除术。第二组作为对照组，使用止血带行子宫肌瘤剔除术。采用Mann-Whitney U检验、卡方检验和Wilcoxon秩和检验进行统计学分析。采用Spearman相关分析（rs、n、p）分析子宫肌瘤剔除术手术时间与术中失血量及剔除肌瘤核数量之间的相关性。
两组患者的术中总失血量、总手术时间、剔除肌瘤核数量（Mann-Whitney U检验）及发热发病率（卡方检验）相似（P>.05）。子宫肌瘤剔除术手术时间与术中失血量及剔除肌瘤核数量之间存在显著正相关（rs =.9，n = 52，P =.000）。止血带组有1例患者术后出血，需行急诊剖腹探查及双侧髂内动脉结扎术。
尽管在剖宫产子宫肌瘤剔除术中，双侧子宫动脉上行支结扎术与使用止血带在术中失血方面效果相似，但由于结扎的永久性，其在术后失血方面的疗效仍持续存在。由于手术结束时止血带会被移除，因此止血带方法在术后无效。因此，在剖宫产子宫肌瘤剔除术中，双侧子宫动脉上行支结扎术可能更可取。
