产科急症子宫切除术51例临床分析  

Clinical Analysis of 51 Cases of Emergency Peripartum Hysterectomy

作　　者：王马列[1] 郑菊[1] 祝彩霞[1] 梁润彩[1] WANG Ma-lie ZHENG Ju ZHU Cai-xia LIANG Run-cai(Department of Gynecology and Obstetrics, The First Afiliated Hospital, SunYat-sen University, Guangzhou510080, China)

机构地区：[1]中山大学附属第一医院妇产科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2016年第5期757-762,共6页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】探讨产科急症子宫切除术的发生率、适应症、高危因素及临床特点。【方法】回顾性分析2004年4月至2015年10月在我院诊治的51例急症子宫切除术病例的临床资料。按切除子宫的手术指征分为:胎盘植入组36例,宫缩乏力组13例及其他因素组2例。【结果】我院产科急症子宫切除术的发生率为1.6‰(51/31923),其中剖宫产49例,占96.07%,阴道分娩2例,占3.93%。手术指征为:胎盘植入36例,占70.59%,宫缩乏力13例,占25.49%,子宫破裂及子宫阔韧带血肿各1例,占3.92%。36例胎盘植入中既往剖宫产史者有23例,占63.89%,前置胎盘有30例,占83.33%。剖宫产及经产妇这两个因素与产科急症子宫切除术密切相关(P=0.000)。胎盘植入组实施全子宫切除术比例高,且常在剖宫产术时进行,而宫缩乏力组实施次全子宫切除术比例高,且多在剖宫产术后进行。【结论】胎盘植入是产科急症子宫切除术的最主要原因。剖宫产及经产妇是产科急症子宫切除术的高危因素。降低剖宫产率及多产率,可以有效降低产科急症子宫切除术的发生率。在决定行急症子宫切除术时,应个体化处理,根据病情及患者意愿决定手术方式。[Objective ] To investigate the incidence, indications, risk factors and clinical features of emergency peripartum hysterectomy. [ Methods ] A retrospective analysis of 5 l cases of emergencyperipartum hysterectomy were studied from April 2004 to October 2005 in our department.According to the surgical indications, these cases were divided into three groups, including placenta increta group （36 cases）, atonic uteri group （13 cases） and other factors group （2 cases）. [Results] The incidence of emergencyperipartum hysterectomy was 1.6%o （51/31923）, with 49 cases of cesarean delivery （96.07%） and vaginal delivery in 2 cases （3.93%）.Indications of emergency peripartum hysterectomy included placenta increta （70.59%）, atonic uteri （25.49%）, uterine rupture and hematoma of the broad ligament （3.92%）.There were 23 cases with prior cesarean section and 30 cases with placenta previa in 36 cases of placenta increta. Both cesarean delivery and multipara were strong risk factors for emergency peripartum hysterectomy （P = 0.000）.Placenta increta group had higher proportion of total hysterectomy which was often performed in cesarean section, while atonic uteri group had higher proportion of subtotal hysterectomy whichwas often performed after cesarean section. [ Conclusion ] The most common factorleading to emergency peripartum hysterectomy was placenta increta.Both cesarean delivery and muhipara were strong risk factors for emergency peripartum hysterectomy.The incidence of emergency peripartum hysterectomy can be effectively reducedwith decreasing the rate of cesarean section and multipara. The surgical method of emergency peripartum hysterectomy should be individualized, according to the illness and the patient＇ s will.

关 键 词：产科急症子宫切除术 产后出血 胎盘植入 宫缩乏力 前置胎盘 剖宫产史 

分 类 号：R71[医药卫生—妇产科学]