腹腔镜子宫肌瘤剔除术后妊娠子宫破裂的临床特点分析  

Clinical characteristics of uterine rupture after laparoscopic myomectomy

作　　者：张春梅[1,2] 陈燕 赵诚[1] 原鹏波[1] 魏瑗[1] 赵扬玉[1] Zhang Chunmei;Chen Yan;Zhao Cheng;Yuan Pengbo;Wei Yuan;Zhao Yangyu(Department of Obstetrics and Gynecology,Peking University Third Hospital,Bejing 100191;Department of Obstetrics and Gynecology,Tangshan Maternal and Child Health Hospital,Tangshan Hebei 063000;Department of Obstetrics and Gynecology,Sinan People's Hospital,Tongren Guizhou 565100,P.R.China)

机构地区：[1]北京大学第三医院妇产科,北京1001911 [2]唐山市妇幼保健院妇产科,河北唐山063000 [3]铜仁市思南县人民医院妇产科,贵州铜仁565100

出　　处：《中国计划生育和妇产科》2022年第11期53-57,共5页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的 研究腹腔镜子宫肌瘤剔除术(laparoscopic myomectomy, LM)后妊娠子宫破裂的特点和危险因素。方法 通过检索数据库2005~2021年22篇中外文献,收集LM后妊娠子宫破裂病例共61例和近10年北京大学第三医院2例LM后妊娠子宫破裂病例,记录其临床资料,分析LM后妊娠子宫破裂的临床特点。结果 孕妇平均年龄(33.6±3.6)岁;LM后避孕时间中位数为24个月;发生子宫破裂孕周在10~41周,中位数为孕33周;肌瘤平均大小(4.5±2.4)cm;单发肌瘤占67.6%,多发肌瘤占32.4%;穿透宫腔病例占28.1%,未穿透宫腔病例占71.9%;患者均采用双极电凝止血,其中未缝合占13.8%,单层缝合占37.9%,双层及三层缝合占48.3%;进入产程占18.2%,未进入产程占81.8%;平均出血量1 842 mL。孕产妇死亡率2.0%(1/49例),围产儿死亡率40.8%(20/49例)。子宫破裂发生在28周后有46例,占73.0%;死胎死产发生在24+~28周最多,占35.0%;新生儿重度窒息发生在孕28+~32周最多,占50%;子宫破裂、产后出血≥1 000 mL、产妇休克均于孕32+~37周发生最多。结论 LM后妊娠子宫破裂往往发生于孕中晚期,其母婴结局差,因此关注孕中晚期孕妇腹痛、出血及胎心异常等子宫破裂先兆表现尤其重要,做到早诊断、早干预,以改善母胎预后。Objective To study the characteristics and risk factors of uterine rupture after laparoscopic myomectomy(LM).Methods By searching the database of 22 Chinese and foreign literatures from 2005 to 2021,61 cases of uterine rupture after LM and 2 cases of uterine rupture after LM in Peking University Third Hospital in recent 10 years were collected.Their clinical data were recorded, and the clinical characteristics of uterine rupture after LM were analyzed.Results The average age of pregnant women was(33.6±3.6)years old.The median contraceptive time after LM was 24 months.The median gestational age of uterine rupture was 33 weeks(range 10~41 weeks).The average size of fibroids was(4.5±2.4) cm.Single fibroids accounted for 67.6% and multiple fibroids accounted for 32.4%.28.1% of the cases penetrated the uterine cavity, and 71.9% of the cases did not penetrate the uterine cavity.All patients were treated with bipolar electrocoagulation for hemostasis, of which 13.8% were unstitched, 37.9% were single-layer stitched, 48.3% were double-layer or three-layer stitched.18.2% were in labor and 81.8% were not.The average blood loss was 1 842 mL.The maternal mortality rate was 2.0%(1/49 cases),and the perinatal mortality rate was 40.8%(20/49 cases).Uterine rupture occurred after 28 weeks in 46 cases(73.0%).Stillbirth occurred most frequently at 24+~28 weeks, accounting for 35.0%.Neonatal severe asphyxia occurred most frequently at 28+~32 weeks of gestation, accounting for 50%.Uterine rupture, postpartum hemorrhage ≥1 000 mL,and maternal shock occurred most frequently at 32+~37 weeks of gestation.Conclusion Uterine rupture after LM often occurs in the middle and late stage of pregnancy, which has poor maternal and infant outcomes.Therefore, it is especially important to pay attention to the presymptoms of uterine rupture in the middle and late stage of pregnancy, such as abdominal pain, bleeding and fetal heart abnormality.Early diagnosis and early intervention can improve the maternal-fetal prognosis.

关 键 词：子宫破裂 腹腔镜子宫肌瘤剔除术 危险因素 

分 类 号：R713.4[医药卫生—妇产科学] R714.2[医药卫生—临床医学]