产后急诊子宫切除37例临床分析  

Clinical Analysis of 37 Patients with Emergency Peripartum Hysterectomy

作　　者：苏妍 陆海茜 陈勤芳[1] 何晓英 SU Yan;LU Haiqian;CHEN Qinfang(Department of Gynecology and Obstetrics,International Peace Maternity&Child Health Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200030,China)

机构地区：[1]上海交通大学医学院附属国际和平妇幼保健院妇产科上海市胚胎源性疾病重点实验室上海市临床重点专科(建设项目)-"强主体"妇产科,上海200030

出　　处：《实用妇产科杂志》2020年第9期710-713,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:分析产后急诊子宫切除术(EPH)的发生率、临床特点、手术指征、并发症,总结临床治疗经验,以期寻找解决此类临床棘手病例的最佳治疗手段。方法:采用回顾性资料分析方法,对2008年1月至2018年12月在上海交通大学医学院附属国际和平妇幼保健院行EPH的37例临床资料进行整理分析。结果:近十年来本院分娩总数152056例,EPH 37例,发生率约0.24‰。37例患者均接受全子宫切除术,其中10例为初产妇,27例为经产妇;28例既往有人工流产史,22例既往有剖宫产史。临床表现主要为胎盘异常和产前出血共27例(73%)。手术适应证主要为前置胎盘伴植入26例(70%)、凶险性前置胎盘及胎盘前置状态22例(59%)、前置胎盘无植入5例(14%)等。37例患者均接受预防性抗生素治疗,术中最常见的并发症是膀胱损伤4例(11%),术后常见的并发症主要有凝血障碍20例(54%),伤口感染5例(14%)。所有患者均接受了复苏和输血管理,红细胞平均输注量为17.00±10.98 U(6~58 U),EPH术后均接受重症监护(ICU)特级护理治疗,术后住院的中位时间为8天(4~29天),无产妇死亡,无新生儿死亡。结论:凶险性前置胎盘或胎盘前置状态导致的产后出血是EPH的主要手术指征。特别是对于保守治疗无效的患者,子宫切除术是降低急症围产期母儿死亡率的有效手段。Objective:To analyze the incidence,clinical characteristics,indications and complications of emergency peripartum hysterectomy(EPH)performed in International Peace Maternity and Child Health Hospital.The object of this study is to sum up experiences.Methods:Clinical data was retrospectively collected and analyzed from 37 patients who underwent EPH from January 2008 to December 2018 in Department of Gynecology and Obstetrics,International Peace Maternity&Child Health Hospital.Results:A total of 152056 births were screened from Jan 2008 to Dec 2018,and 37 cases of postpartum emergency hysterectomy were included into our analysis,with an incidence rate of about 0.24‰.All 37 patients underwent total hysterectomy,of which 10 were primiparous and 27 were postpartum,28 had a history of induced abortion and 22 had a history of cesarean section.The clinical manifestations were 27 cases of placental abnormalities and prenatal bleeding(73%).The main surgical indications were 26 cases(70%)with placenta previa,22 cases(59%)with dangerous placenta previa,and 5 cases(14%)without placenta previa.All 37 patients received prophylactic antibiotics,and the most common complication after surgery was bladder injury,occurred in 4 cases(11%).All patients received resuscitation and blood transfusion management.The average red blood cell transfusion volume was 17.00±10.98 units(6 to 58 units).All patients received intensive care(ICU)special care after EPH.The median time of postoperative hospitalization was 8 Days(4-29 days),no maternal deaths and no newborn deaths.Conclusions:The main reason of EPH is postpartum hemorrhage caused by pernicious placenta previa with placenta accrete.Hysterectomy is suitable for those who are ineffective to conservative treatments.As well as an effective means to reduce the maternal and infant mortality in perinatal period.

关 键 词：产后出血 急诊子宫切除 凶险型前置胎盘 

分 类 号：R713.42[医药卫生—妇产科学]