非脱垂大子宫阴式切除术后腹腔内大出血6例临床分析  

Analysis of 6 cases of intraabdominal bleeding after transvaginal hysterectomy for large nonprolapsed uterus

作　　者：王文英[1] 鲁永鲜[1] 刘昕[1] 沈文洁[1] 刘静霞[1] 张迎辉[1] 葛静[1] 赵英[1] 牛珂[1] 

机构地区：[1]解放军总医院第一附属医院妇产科,北京100048

出　　处：《感染．炎症．修复》2011年第1期24-26,共3页Infection Inflammation Repair

基　　金：首都医学发展科研基金(2007-2032)

摘　　要：目的:探讨非脱垂大子宫阴式切除术(TVH)术后腹腔内大出血的原因、处理及预防措施。方法:回顾性分析我院自1995年8月-2010年10月行非脱垂大子宫TVH 960例患者中6例术后早期腹腔内大出血并成功止血患者的临床资料。结果:腹腔内大出血共6例,发生率0.62%,其中子宫肌瘤4例,子宫肌腺症2例。子宫平均如孕10周大小,平均重322 g。6例中2例同时行双侧附件切除术。术中出血量50～200 ml,平均100ml。术后早期腹腔内大出血400～1 900 ml,平均1 095 ml。5例经阴道重新结扎止血成功,1例给予止血药、补液等保守治疗后止血成功。结论:非脱垂大子宫TVH术后腹腔内出血是严重的围手术期并发症之一,处理须及时。术中认清解剖、止血彻底是减少此类并发症发生的重要措施。Objective： To find the cause and the prevention methods for intraabdominal bleeding after transvaginal hysterectomy （TVH） for nonprolapsed large uterus. Methods： During August 1995 to October 2010, 960 TVH cases were performed, and intraabdominal bleeding occurred in 6 patients after operation. In all of them hemosta- sis was achieved transvaginally. Results： The rate of postoperative bleeding after TVH was 0.62 %. Among these 6 patients, 4 of them were leiomyoma, 2 were adenomyoma. The uterus of these 6 patients were as large as the size of 10 gestational weeks and weighing 322 g in average. The mean blood loss during operation was 100 ml （50- 200 ml）, the mean posthysterectomy blood loss was 1 095 ml （400-1 900 ml）. Transvaginal hemostasis was suc- cessful in 5 patients, and one patient was treated conservatively with hernostatic drug and fluid infusion, with bleeding stopped spontaneously. Conclusion： Intraabdominal bleeding after TVH is one of severe postoperative complication, therefore management should be taken in time. Accurate identification of the anatomy and careful haemostasis during operation are important measures to reduce such a complication.

关 键 词：阴式子宫切除 平滑肌瘤 腺肌瘤 

分 类 号：R656.8[医药卫生—外科学]