产科急症子宫切除38例临床研究.docVIP

产科急症子宫切除38例临床研究【摘要】:目的:分析子宫切除发生率、手术原因及临床价值。方法:对38例急症子宫切除孕产妇进行回顾性分析。结果:38例子宫切除原因依次为:子宫收缩乏力16例,占42.10%,其中剖宫产中发生12例,阴道分娩2例;子宫破裂8例,占21.05%;胎盘因素6例,占15.79%;晚期产后出血4例,占10.53%,均为剖宫产术后切口愈合不良;妊高征合并HELLP综合征1例,占5.26%;羊水栓塞2例,占5.26%。结论:子宫收缩乏力是产科急症子宫切除的主要手术指征,产科急症子宫切除术是一项抢救危重出血孕产妇生命的重要措施。 【关键词】:急症子宫切除术;子宫收缩乏力;产科出血 【中图分类号】R713.4+2【文献标识码】A【文章编号】1007-8517(2010)06-141-2 Obstetric emergency clinical analysis of 38 cases of hysterectomy [Abstract]:Objective:To analyze the incidence of hysterectomy,surgery causes and clinical value. Method:38 cases of acute maternal hysterectomies were analyzed retrospectively. Results:38 cases of uterine resection of the reasons were as follows:16 cases of uterine contraction weak,accounting for 42.10%,which occurred in 12 cases of cesarean section,vaginal delivery in 2 cases;8 cases of uterine rupture, accounting for 21.05%;placental factor 6 cases, accounting for 15.79%;4 cases of late postpartum hemorrhage,accounting for 10.53%,both bad wound healing after cesarean section;induced hypertension complicated HELLP syndrome in 1 case,accounting for 5.26%;AFE 2 cases,accounting for 5.26%. Conclusion:The uterine contraction fatigue emergency obstetric hysterectomy is a major surgical indications,emergency obstetric hysterectomy is a maternal blood to save life of critically important measures. [Key words]:emergency hysterectomy for obstetric hemorrhage of uterine contraction fatigue 产科出血是分娩期严重并发症,目前仍居我国孕产妇死亡率之首。成功地控制产后出血是降低孕产妇死亡率的关键,产科急症子宫切除是治疗产科大出血抢救孕产妇生命的一项重要措施和手段。本文回顾性分析我院10年来收治经保守治疗不能控制的产科大出血患者的临床资料,对其发生率、手术原因进行总结和分析。 1临床资料 1.1一般资料我院产科自1998年1月～2008年3月共收治孕产妇8376例,其中因产科大出血需急行子宫切除术者38例,发生率0.46%。38例子宫切除患者中,经产妇14例,初产妇24例,孕次最多为孕6次,孕周25～42周,平均38周,年龄最小23岁,最大39岁,平均30岁。38例中20例为农村妇女,18例为城镇居民。 1.2子宫切除原因38例急症子宫切除患者中,16例宫缩乏力者12例在剖宫产术中发现胎儿胎盘娩出后子宫不收缩,呈布囊状,经快速缝合子宫切口,恢复其连续性,按摩子宫,给予缩宫剂,阻断子宫血运,骼内动脉结扎等多种方法处理无效,子宫无张力,每按摩子宫一次,都有约200ml血从阴道内流出,为抢救患者生命边抢救休克边急行子宫切除术;4例为阴道分娩。子宫破裂8例,有6例院外转入,均有不恰当用催产素和米索前列醇史,致子宫强直性收缩,导致子宫破裂,胎儿均游离于腹腔,1例子宫复杂性破裂,向下延至阴道侧壁,向后延及