24例剖宫产术后非计划再次手术病例临床特点分析  

Clinical Analysis of 24 Cases with Re-Laparotomy after Cesarean Section

作　　者：周志梅[1] 张明燕 陈培培 李鲁宏[1] ZHOU Zhimei;ZHANG Mingyan;CHEN Peipei;LI Luhong(Department of Gynaecology and Obstetrics, The Second Affiliated Hospitalof Fujian Medical University, Quanzhou 362000, China)

机构地区：[1]福建医科大学附属第二医院妇产科,泉州362000

出　　处：《福建医科大学学报》2020年第6期432-435,共4页Journal of Fujian Medical University

基　　金：福建省中青年教师教育科研项目(科技类)(JAT190222)。

摘　　要：目的探讨剖宫产术后非计划再次手术的原因及临床特点。方法收集24例剖宫产术后非计划再次手术患者的临床资料,回顾性分析其临床处理过程及预后。结果24例患者剖宫产指征主要是瘢痕子宫(n=7,29.2%)和产程停滞(n=6,25.0%);非计划再次手术的指征主要是腹腔出血(n=13,54.2%)和严重产后出血(n=8,33.3%);术前并发失血性休克16例(66.7%),并发弥散性血管内凝血13例(54.2%);24 h内再次手术19例(79.1%),24~72 h内再次手术5例(20.9%);主要手术方式是止血(n=13,54.2%)和子宫切除(n=12,50.0%);出血量(4633.0±1983.3)mL,输红细胞(3395.8±1986.3)mL、输血浆(1427.0±893.5)mL;术后转重症监护病房治疗13例(54.2%),腹壁切口感染裂开6例(25.0%),肺部感染6例(25.0%);术后住院时间(15.6±7.4)d。所有患者均临床痊愈出院。结论大部分剖宫产术后非计划再次手术是可以避免的,术中需彻底止血;密切监测具有高危因素患者的术后情况,早期识别并及时处理可降低严重并发症的发生率。Objective To investigate the risk factors causing re-laparotomy and the indications,management,and outcomes of re-laparotomy after cesarean section(CS).Methods Clinical data was analyzed retrospectively including 24 cases with re-laparotomy after CS during the study period of January 2011 to December 2019.Results Main indications of CS were previous cesarean(7 cases,29.2%)and arrested labor(6 cases,25.0%).Main indications for re-laparotomy were intra-abdominal bleeding(13 cases,54.2%)and severe postpartum hemorrhage(8 cases,33.3%).The main complications were hemorrhagic shock(16 cases,66.7%)and disseminated intravascular coagulation(13 cases,54.2%).19 cases(79.1%)underwent re-laparotomy during the first 24 hours after CS and 5 cases(20.9%)within 24-72 hours.Procedures that were performed at re-laparotomy were arrest of bleeding(13 cases,54.2%)and hysterectomy(12 cases,50.0%).The mean blood loss was(4633.0±1983.3)mL and red blood cell transfusion was(3395.8±1986.3)mL while plasma transfusion was(1427.0±893.5)mL.13 cases required admission into the intensive care unit(54.2%),and 6 cases had disruption of abdominal wall wound(25.0%),and 6 cases had pulmonary infection(25.0%).The mean days of hospitalization after re-laparotomy was(15.6±7.4)days.There was no case with maternal mortality.Conclusion The majority of these were preventable and could have been avoided if thorough hemostasis were performed at the time of the primary surgery.Close monitoring of patients considered at risk for this complication must be undertaken after CS.Early recognition and treatment of postoperative complications are of vital importance to reduce the occurrence of serious complications.

关 键 词：剖宫产术 产后出血 二次探查手术 围生医学 子宫切除术 

分 类 号：R713.42[医药卫生—妇产科学] R714.46[医药卫生—临床医学]