Ikechebelu J I, Ezeama C O, Obiechina N J A
Department of Obstetrics & Gynaecology, Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, Nigeria.
Niger J Clin Pract. 2010 Jun;13(2):154-8.
Fibroids remain the commonest pelvic tumour seen in women with myomectomy being the major form of treatment in our environment. Techniques to minimize blood loss will reduce patient morbidity and the need for blood transfusions. One such technique is the use of a tourniquet during myomectomy operation. This study examines the effectiveness and safety this tourniquet technique.
A comparative analysis of the blood loss, transfusion rate and the morbidities associated with the use and non-use of a tourniquet during myomectomy operation at Nnamdi Azikiwe University Teaching Hospital, Nnewi Nigeria was undertaken. The Foley's urethral catheter was adapted as a uterine tourniquet and applied as low as possible at the base of the uterus before enucleating the fibroid masses.
The patients who had their myomectomy performed with application of a tourniquet [tourniquet group] and those without [no-tourniquet group] were evenly matched for age, parity and presenting symptoms. The overall mean age of patients was 35.7 +/- 6.1 years and parity was 0.40 +/- 1.25. The main presenting symptoms of the patients were lower abdominal mass 65.6%, menorrhagia 38.7%, infertility 33.3%, abdominal pain 19.4% and dysmenorrhoea 14.0%. There was a statistically significant difference [P < 0.001] in mean blood loss for the no-tourniquet group [756.4 +/- 285.7] and the tourniquet group [515.7 +/- 292.8] as well as the mean blood transfusion rate in no-tourniquet group [1.0 units +/- 1.14] and the tourniquet group [0.24 units +/- 0.51]. However there was no significant difference between the two groups with respect to complication profile.
The Foley's catheter form of tourniquet is cheap, safe, effectively reduces blood loss during myomectomy and significantly reduces transfusion rate while not adding to the complications due to the operation.
子宫肌瘤仍然是女性中最常见的盆腔肿瘤，在我们所处的环境中，肌瘤切除术是主要的治疗方式。减少失血的技术将降低患者的发病率以及输血需求。其中一种技术是在肌瘤切除术中使用止血带。本研究探讨了这种止血带技术的有效性和安全性。
对尼日利亚纽维市纳姆迪·阿齐克韦大学教学医院在肌瘤切除术中使用和不使用止血带的失血情况、输血率及相关发病率进行了对比分析。将福勒氏尿道导管改装为子宫止血带，并在切除肌瘤前尽可能低位地应用于子宫底部。
使用止血带进行肌瘤切除术的患者（止血带组）和未使用止血带的患者（无止血带组）在年龄、产次和主要症状方面匹配良好。患者的总体平均年龄为35.7±6.1岁，产次为0.40±1.25。患者的主要症状为下腹部肿块（65.6%）、月经过多（38.7%）、不孕（33.3%）、腹痛（19.4%）和痛经（14.0%）。无止血带组的平均失血量（756.4±285.7）与止血带组（515.7±292.8）以及无止血带组的平均输血率（1.0单位±1.14）与止血带组（0.24单位±0.51）之间存在统计学显著差异（P<0.001）。然而，两组在并发症方面无显著差异。
福勒氏导管形式的止血带价格便宜、安全，能有效减少肌瘤切除术中的失血并显著降低输血率，同时不会增加手术并发症。
