穿透性胎盘植入致子宫破裂8例病例分析  

Analysis of 8 cases of uterine rupture caused by placenta percreta

作　　者：杨春丽[1] 洪腾[1] 崔世红[1] 杨敬敬[1] 郭晓丽[1] YANG Chun-li;HONG Teng;CUI Shi-hong;YANG Jing-jing;GUO Xiao-li(Department of Obstetrics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院产科,郑州450052

出　　处：《医药论坛杂志》2021年第2期1-4,共4页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190366)。

摘　　要：目的探讨穿透性胎盘植入导致完全性子宫破裂的病因、临床特点及结局。方法回顾性分析2013年1月—2020年8月郑州大学第三附属医院收治的因穿透性胎盘植入导致子宫破裂病例3例,同时在中国知网和PubMed数据库检索文献报道的穿透性胎盘植入导致子宫破裂病例5例,对患者一般资料及发病、治疗过程进行归纳总结。结果8例子宫破裂均有剖宫产史,此次妊娠合并前置胎盘并植入,术中诊断完全子宫破裂,其中1例术前无明显症状,术中发现子宫破裂,其余7例术前均有症状,主要表现为持续腹痛,腹部压痛及反跳痛;无痛性阴道出血;上腹部及右肩部急性疼痛;胸闷、心慌、呼吸困难、晕厥等失血性休克表现。妊娠结局:8例完全性子宫破裂患者中,4例行子宫破裂修补术,4例行子宫切除术,其中4例因胎盘植入侵犯膀胱行膀胱修补术,均发生产后出血并给予输血治疗。其中2例因出血多发生失血性休克。新生儿情况:4例因孕周小,胎儿无存活能力,大于28周的有4例,其中3例新生儿预后良好。患者均治愈出院。结论对于胎盘植入患者应警惕穿透性植入导致子宫破裂发生,一旦确诊子宫破裂应立即终止妊娠,有利于改善母儿结局。Objective To explore the etiology,clinical features and outcome of complete uterine rupture caused by placenta percreta.Methods A retrospective analysis of 3 cases of uterine rupture caused by placenta percreta in the third affiliated hospital of Zhengzhou University from 2013 to the present was performed.At the same time,5 reported cases of uterine rupture caused by placenta percreta with detailed data retrieved from Chinese National Knowledge Infrastructure and PubMed databas.Summarize the patient’s general information,morbidity and treatment process.Results Totally 8 cases of uterine rupture have a history of cesarean section.The pregnancy was combined with placenta previa and implantation.During the operation,a complete uterine rupture was diagnosed.Among them,1 case had no obvious symptoms before the operation,and uterine rupture was found during the operation.The remaining 7 cases Symptoms before surgery,mainly manifested as persistent abdominal pain,abdominal wall tenderness and rebound pain;Painless vaginal bleeding;acute pain in the upper abdomen and right shoulder;Chest tightness,palpitation,difficulty breathing,posterior syncope Ischaemic shock manifestations.Pregnancy outcomes:Of the 8 patients with complete uterine rupture,4 cases underwent uterine rupture repair and 4 cases underwent hysterectomy,of which 4 cases underwent bladder repair due to placenta implantation,all of which were postpartum.Bleeding and giving blood transfusion treatment.Two of them suffered from hemorrhagic shock due to bleeding.Newborn condition:4 cases had small gestational weeks and the fetus had no ability to survive.Among them,4 cases greater than 28 weeks,3 of whom had a good prognosis.The patients were discharged after being cured.Conclusion Patients with placenta increta should be wary of uterine rupture causedby placentapercreta.Once the diagnosis of uterine rupture is confirmed,pregnancy should be terminated immediately,which is conducive to improving maternal and child outcomes.

关 键 词：前置胎盘 胎盘植入 子宫破裂 

分 类 号：R714.46[医药卫生—妇产科学]