Key Laboratory of Reproductive Genetics (Ministry of Education) and Department of Obstetrics Women's Hospital, Zhejiang University School of Medicine, 1st Xueshi Road, Hangzhou, Zhejiang, 310006, China.
Arch Gynecol Obstet. 2020 Feb;301(2):465-472. doi: 10.1007/s00404-020-05435-3. Epub 2020 Jan 29.
To report a novel method to achieve hemostasis and to evaluate efficacy and safety of controlling hemorrhage from the lower uterine segment (LUS) during cesarean section for placenta previa and accrete compared with conventional surgery.
From January 2017 to June 2019, there were 65 cases of pernicious placenta previa admitted in our obstetric department. They all had performed selective cesarean sections. Transverse parallel compression suture was applied in 32 cases during cesarean sections. The bladder was reflected downward till the lowest point of placenta implanted. Two plastic drains were inserted into internal and through the external os, as a support for compressing and draining the uterine cavity. First, at one side of LUS, a Vicryl number one stitch was inserted borderline of myometrium from the anterior to the posterior. The stitch was then inserted borderline of myometrium from the posterior to anterior at the other side in horizontal direction and tightened on the anterior wall of uterine surface. Another suture was inserted superiorly or inferiorly to the first one, at 1 cm interval. Then, such sutures were stitched until the bleeding and dilated LUS became all compressed. The uterine incision was then stitched [group 1 (Gr1)]. Other 33 cases were managed with conventional surgery [group 2 (Gr2)]. The efficiency of this novel technique, in term of blood loss, operation time, the intensive-care unit (ICU) admission rate and hospitalization time after surgery, complications, and postoperative recovery, was compared over the same period.
With our transverse parallel compression suture, we were able to preserve the uterus in all cases, while two patients underwent hysterectomy in Gr2. Our success rate in hemostasis was 93.8% (30/32). The operation time, the length of ICU stay, and the rate of ICU admission of Gr1 were lower than Gr2. All patients resumed a normal menstrual flow, and no long-term complications were observed during follow-up.
Transverse parallel compression suture is an easy, effective, and safe method to stop bleeding from the lower uterine segment in women with placenta previa and accrete.
报道一种新的方法来实现止血，并评估其在控制前置胎盘和胎盘粘连剖宫产术中下段（LUS）出血的疗效和安全性，与传统手术相比。
2017 年 1 月至 2019 年 6 月，我院产科收治凶险性前置胎盘患者 65 例，均行择期剖宫产术。术中采用横向平行压缩缝合 32 例。将膀胱向下翻转至胎盘植入的最低点。将两根塑料引流管插入宫腔内和通过宫颈外口，作为压迫和引流宫腔的支撑。首先，在 LUS 的一侧，将薇乔 1 号线从子宫前壁到后壁插入子宫肌层边缘。然后，在另一侧以水平方向从前向后插入子宫肌层边缘，并在子宫表面前壁收紧。在第一个缝线的上方或下方间隔 1cm 插入另一个缝线。然后，缝合这些缝线，直到出血和扩张的 LUS 全部被压缩。然后缝合子宫切口[第 1 组（Gr1）]。另外 33 例采用传统手术治疗[第 2 组（Gr2）]。比较同期两种不同手术方式在出血量、手术时间、术后 ICU 入住率和住院时间、并发症和术后恢复等方面的效果。
采用横向平行压缩缝合，我们能够在所有病例中保留子宫，而 Gr2 中有 2 例患者行子宫切除术。我们的止血成功率为 93.8%（30/32）。Gr1 的手术时间、ICU 住院时间和 ICU 入住率均低于 Gr2。所有患者均恢复正常月经来潮，随访期间无长期并发症。
横向平行压缩缝合是一种简单、有效、安全的方法，可用于治疗前置胎盘和胎盘粘连的妇女下段出血。
