Songthamwat Srisuda, Songthamwat Metha
Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand,
Int J Womens Health. 2018 Aug 24;10:487-492. doi: 10.2147/IJWH.S170460. eCollection 2018.
The aim of this study was to report our clinical experience of applying a uterine flexion suture, which was modified from the B-Lynch uterine compression suture, for treating uterine atony during cesarean section.
This is a retrospective descriptive study describing the use of a new technique, uterine flexion suture, for treating uterine atony during cesarean section. The study period was from January 2009 to December 2017 at Udonthani Hospital, Udonthani, Thailand. Uterine atony during cesarean section was treated by manual compression, intravenous oxytocin, methylergonovine maleate, and prostaglandins and then was observed for 10-15 minutes before applying a uterine flexion suture in the failed medical treatment cases. The patients were observed for vaginal bleeding, hematometra, and infection after operation. Uterine ultrasound scan results on days 1, 7, and 30 postoperation were also reviewed.
Fifty-seven patients with uterine atony during cesarean delivery received the uterine flexion suture. The mean age of patients was 27.0 (15-44 years). Thirty-four patients were primipara. The indications for cesarean section were cephalopelvic disproportion in 27 (47.4%) cases, and previous cesarean section in 11 (19.3%) cases. Neither postoperative excessive bleeding nor hysterectomy was observed. There was no hematometra or serious postoperative complication after surgery. The estimated time for uterine flexion suture is only 2-3 minutes and was very easy to perform.
Uterine flexion suture technique, which was modified from the B-Lynch suture, was inexpensive, quick, and effective in the treatment of atonic postpartum uterus in women undergoing cesarean section.
本研究旨在报告我们应用改良自B-Lynch子宫压迫缝合术的子宫屈曲缝合术治疗剖宫产术中子宫收缩乏力的临床经验。
这是一项回顾性描述性研究，描述了一种新技术——子宫屈曲缝合术在剖宫产术中治疗子宫收缩乏力的应用。研究时间段为2009年1月至2017年12月，地点为泰国乌隆他尼府的乌隆他尼医院。剖宫产术中子宫收缩乏力的治疗方法包括手法压迫、静脉注射缩宫素、马来酸麦角新碱和前列腺素，在药物治疗无效的病例中，于10 - 15分钟后应用子宫屈曲缝合术。术后观察患者的阴道出血、宫腔积血和感染情况。还回顾了术后第1天、第7天和第30天的子宫超声扫描结果。
57例剖宫产术中子宫收缩乏力患者接受了子宫屈曲缝合术。患者的平均年龄为27.0岁（15 - 44岁）。34例为初产妇。剖宫产的指征中，头盆不称27例（47.4%），既往剖宫产史11例（19.3%）。未观察到术后大出血或子宫切除术。术后无宫腔积血或严重并发症。子宫屈曲缝合术估计时间仅为2 - 3分钟，且操作非常简便。
改良自B-Lynch缝合术的子宫屈曲缝合术在治疗剖宫产术后子宫收缩乏力方面价格低廉、快速且有效。
