子宫穿孔42例临床分析.docVIP

精品论文 参考文献 子宫穿孔42例临床分析 谢立慧（河南平舆县计划生育服务站 463400） 【中图分类号】R713【文献标识码】A【文章编号】2095-1752（2011）22-0180-02 【摘要】目的 探讨妇产科手术导致子宫穿孔的易发因素及诊治.预防措施。方法 对妇产科手术操作所致的子宫穿孔的病例进行回顾性分析。结果 对42例穿孔手术发现，多发生于人流术(60%），孕12-14周钳刮术（20%），上环手术（10%），取环手术（10%）。结论 我计划生育服务站每年引流产手术约2000例，子宫穿孔发生率每年为0.22-0.3%，并发症一般较轻，严重并发症病例如肠管。膀胱损伤者少见，应严格操作规程，上取环术及人流术多为盲视手术，凭经验和感觉操作，熟练掌握子宫位置。局部解剖关系，对高危妊娠者，应小心谨慎操作，是预防子宫穿孔的关键。 【关键词】子宫穿孔 人流术 【Abstract】Pick to objective to study the operation of obstetrics and gynecology in uterine cross-bred factors and make a diagnosis and give treatment. Preventive measures. Methods the operation of obstetrics and gynecology caused by uterine cases were retrospectively analyzed. Results Of 42 patients with perforated surgery, people are found, was born in technique (60%), and pregnant 12 to 14 weeks clamp technique (20%), scraping the ring surgery (10%), for ring surgery (10%). Conclusion My family planning service station every year about 2000 cases lead abortion, uterine rate from 0.22 to 0.3% a year, in a light, serious complications such as bowel disease complications. Bladder injury were rare, should strictly operation regulations, for ring on art and occupied more than art for blindness surgery, with experience and feeling operation, master the position. Local anatomic relationship, to high-risk pregnancy, who should be careful operation, the key is to prevent uterine. 【Key words】uterine operation flow 妇产科手术导致子宫穿孔的发生率国内外报道不一，国内为0.05%-0.88%,国外发生率0.09%-0.2%，症状轻或无症状的微小穿孔难以发现。现由于腹腔镜技术的开展应用，使原来可疑的穿孔得以证实，使人工流产的穿孔发生率升高。对于子宫穿孔的易发因素，术前应积极采取预防措施，在B操引导下操作或行超导可视人流术，术中小心谨慎操作，无疏忽大意;一旦发生穿孔，应积极恰当处理，避免感染和内出血的发生。 1 临床资料 1.1 一般资料 1992.12-2010.12我计生服务站妇产科门诊及病房共行引流产、上环手术约16200例，发生子宫穿孔42例，年龄18-42岁，平均年龄31岁，其术中发现38例，及时 给与处理；上环导致的穿孔术中 发现2例，术后2个月-2年发现节育环穿入腹腔2例，入膀胱内1例，穿透肠管1例，发现后及时行开腹手术。人流术2例为探针穿孔，28例为吸宫头穿孔，5例为钳刮术卵圆钳穿孔，取环勾穿孔2例，诊刮术小刮匙穿孔1例; 1.2 子宫穿孔的诊断 手术操作过程中，操作者器械落空感，宫腔深度异常，受术者突感下腹疼痛，有时见到吸出或卵圆钳夹出黄色大网膜组织，可确诊无疑。还可用B超或宫腔镜辅助诊断。小的探针穿孔B超临床可见无典型声像图；吸宫头和卵圆钳及刮勺穿孔B超可见子