Taylor A, Sharma M, Tsirkas P, Di Spiezio Sardo A, Setchell M, Magos A
Minimally Invasive Therapy Unit and Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, Royal Free Hospital, Hampstead, London NW3 2QG, UK.
BJOG. 2005 Mar;112(3):340-5. doi: 10.1111/j.1471-0528.2004.00430.x.
To evaluate triple tourniquets in controlled conditions and for the first time to investigate the hypothesis that leaving a semi-permanent tourniquet around the uterine artery reduces post-operative bleeding from the uterine incisions.
A randomised controlled trial.
Two University teaching hospitals.
Twenty-eight patients with symptomatic fibroids and uterine sizes ranging from 14 to 24 weeks of gestation undergoing open myomectomy.
A number 1 polyglactin suture was tied around the cervix to occlude the uterine arteries, and polythene tourniquets were tied around the infundibulopelvic ligament to obstruct the ovarian vessels. At the end of the procedure, the ovarian ties were released but the uterine artery suture remained in situ.
Intra-operative blood loss, post-operative blood loss, blood transfusion rates, operative morbidity, uterine blood flow and ovarian function.
There was significantly less blood lost in the tourniquet group than in the control group (difference between means 1870 mL, 95% CI 1159-2580 mL, P < 0.0001; transfusion rates of 7% and 79%, P= 0.0003). The volume in the pelvic drain 20 min post-operatively and after 48 hours failed to reach statistical significance between the two groups (P= 0.10 and P= 0.165). There were no differences in uterine artery Doppler resistance indices at five days (P= 0.54), six weeks (P= 0.47), three months (P= 0.49) and at six months (P= 0.18). Day two serum FSH concentrations after surgery were unchanged (P= 0.45), compared with baseline values.
Triple tourniquets are effective in reducing bleeding and transfusion rates. There appears no obvious adverse effect on uterine perfusion or ovarian function.
在可控条件下评估三重止血带，并首次研究在子宫动脉周围留置半永久性止血带可减少子宫切口术后出血这一假说。
一项随机对照试验。
两家大学教学医院。
28例有症状的子宫肌瘤患者，子宫大小相当于妊娠14至24周，接受开放性子宫肌瘤切除术。
用1号聚乙醇酸缝线在宫颈周围打结以阻断子宫动脉，用聚乙烯止血带在漏斗骨盆韧带周围打结以阻断卵巢血管。手术结束时，松开卵巢结扎线，但子宫动脉缝线仍留在原位。
术中失血量、术后失血量、输血率、手术并发症、子宫血流和卵巢功能。
止血带组的失血量明显少于对照组（均值差异为1870 mL，95%可信区间为1159 - 2580 mL，P < 0.0001；输血率分别为7%和79%，P = 0.0003）。术后20分钟和48小时盆腔引流液量在两组间未达到统计学显著性差异（P = 0.10和P = 0.165）。术后五天（P = 0.54）、六周（P = 0.47）、三个月（P = 0.49）和六个月（P = 0.18）时子宫动脉多普勒阻力指数无差异。术后第二天血清促卵泡激素浓度与基线值相比无变化（P = 0.45）。
三重止血带在减少出血和输血率方面有效。对子宫灌注或卵巢功能似乎没有明显的不良影响。
