Price Natalia, B-Lynch Christopher
Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford, England, UK.
Int J Fertil Womens Med. 2005 Jul-Aug;50(4):148-63.
Massive uncontrolled hemorrhage after childbirth is a leading cause of the pregnancy-related death and resulting morbidity. Uterine atony is the most common cause (75-90%) of primary postpartum hemorrhage. When simple massage of the uterus and uterotonics such as oxytocins, syntometrine and prostaglandins failed to manage this condition, various surgical solutions have been sought, including uterine artery ligation, more complicated stepwise devascularization of the uterus, internal iliac artery ligation and, ultimately, hysterectomy. All these procedures require above average surgical skill. In contrast, the B-Lynch suturing technique (brace suture) is particularly useful because of its simplicity of application, life saving potential, relative safety and capacity for preserving the uterus and subsequent fertility. The adequacy of haemostasis can be assessed both before and immediately after application of the suture. Only if it fails need other more radical surgical methods be considered. The special advantage of this innovative technique is that it presents an alternative to major surgical procedures for controlling pelvic arterial pulse pressure or hysterectomy. To date, this suturing technique, when applied correctly, has been successful with no problems and no apparent complications. This review provides an update on the B-Lynch brace suturing technique, including choice of suture material, use of the technique in early and late gestation, and comparison with other uterine compression surgical techniques. It also includes a comprehensive review and analysis of all published cases and their postoperative follow-up.
产后大量难以控制的出血是导致孕产妇死亡及发病的主要原因。子宫收缩乏力是原发性产后出血最常见的原因（占75%-90%）。当单纯的子宫按摩以及使用缩宫素、欣母沛和前列腺素等宫缩剂无法控制这种情况时，人们寻求了各种手术解决方案，包括子宫动脉结扎、更复杂的逐步子宫去血管化、髂内动脉结扎，最终是子宫切除术。所有这些手术都需要高于平均水平的手术技巧。相比之下，B-Lynch缝合术（支撑缝合）特别有用，因为其应用简单、有挽救生命的潜力、相对安全且能够保留子宫及后续生育能力。在缝合应用前和应用后即刻都可以评估止血是否充分。只有在其失败时才需要考虑其他更激进的手术方法。这项创新技术的特殊优势在于它为控制盆腔动脉脉压或子宫切除术的主要外科手术提供了一种替代方案。迄今为止，这种缝合技术在正确应用时一直成功，没有出现问题和明显并发症。这篇综述提供了关于B-Lynch支撑缝合术的最新信息，包括缝合材料的选择、该技术在妊娠早期和晚期的应用，以及与其他子宫压迫手术技术的比较。它还包括对所有已发表病例及其术后随访的全面综述和分析。
