剖宫产大出血行改良式部分子宫切除术的临床应用

Application of Modified Partial Hysterectomy for Massive Hemorrhage from Cesarean Section

目的探讨剖宫产大出血患者行改良式部分子宫切除术的疗效。方法回顾性分析2001年1月至2004年6月我院因剖宫产大出血40例患者的临床资料,其中24例行改良式部分子宫切除术(观察组),16例行传统子宫切除术(对照组)。观察两组手术时间、止血时间、术中出血量、住院日及术后月经、更年期症状、性激素水平。结果两组均控制了子宫大出血,挽救了生命,其手术时间、止血时间、术中出血量、住院日比较均无统计学差异(P>0.05)。但术后6个月、12个月时观察组血清雌激素(E2)高于对照组(P<0.01),12个月时促卵泡激素(FSH)、促黄体激素(LH)均高于对照组(P<0.05)。观察组均于5～13月恢复月经,经期正常,对照组62.5%(10/16)术后2年内出现更年期症状,两组比较差异显著(P<0.01)。结论改良式部分子宫切除对剖宫产大出血能有效止血,同时保留了卵巢功能,对剖宫产大出血经其他保守治疗无效时可选择本术式。

Objective To investigate the effect of modified partial hysterectomy for massive hemorrhage from cesarean section. Method 40 cases of massive hemorrhage from cesarean section were retrospectively reviewed, including 24 cases underwent modified partial hysterectomy （study group） , 16 cases underwent con- ventional hysterectomy（ control group）. The operative duration, time-taking of stopping the bleeding, blood loss, hospitalized stay, postoperative catamenia, gonadal hormone concentration were observed. Result Hemostasis achieved in all cases of both group and no death occurred. There was no significant difference between two groups in terms of operative duration, time-taking of stopping the bleeding, blood loss and hospitalized stay（P 〉0.05）. There were significant elevation of E2 at 6, 12 months postoperatively（P 〈 0.01 ）, and FSH, LH at 12 months postoperatively （P 〈 0.05 ） in study group compared with control group. Menstruation returned regularly in all cases of study group within 5 to 13 months postoperatively, climacteric symptom occurred in 62.5% cases of control group, showing significant difference between these two groups（ P 〈0.01 ）. Conclusion Modified hysterectomy is effective to stop massive bleeding after cesarean section and preserve the function of ovaries.