子宫切除术在妊娠合并重型肝炎救治中的价值

The value of hysterectomy in treatment of hepatitis gravis during pregnancy.

目的探讨子宫切除术对妊娠合并重型肝炎产妇预后的影响。方法回顾1994—2007年间38例手术终止妊娠的妊娠合并重型肝炎病例资料，分为剖宫产组以及剖宫产加子宫切除组，其中剖宫产组20例，剖宫产加子宫切除组18例，对比两组年龄、孕周、孕次，对比分娩前及产后24h血清胆红素、血清胆固醇、凝血酶原活动度、血清肌酐、血清胆碱酯酶以及肝性脑病和肝肾综合征的发生情况，对比产后出血、产褥感染及病死率。统计方法采用t检验，Fisher’s精确概率法和秩和检验。结果两组患者分娩前各指标差别无显著性；分娩后两组患者的血清胆红素、凝血酶原活动度、血清肌酐，肝肾综合征、产后出血、产褥感染、病死率差异有显著性，血清胆固醇、血清胆碱酯酶以及肝性脑病在两组间差别无显著性。结论剖宫产同时行子宫切除术可改善妊娠合并重型肝炎产妇的预后。

Objective To explore effect of hysterectomy on the prognosis of parturients with hepatitis gravis. Methods There 38 hepatitis gravis patients during pregnancy were terminated pregnancy by operation between 1994 and 2007 and the results were analyzed. The patients were divided into caesarean section group consisted of 20 cases and caesarean section plus hysterectomy group consisted of 18 cases based on delivery mode. The indexes of age, weeks of gestation and times of pregnancy, levels of serum total bilirubin, serum cholesterol, plasma thromboplastin activity, serum creatine, serum cholinesterase, the incidence of hepatic encephalopathy, the conditions of hepato - renal syndrome before and after delivery, postpartum hemorrhage, puerperal infection and the mortality were compared between the two groups using t - test, fisher＇ s exact test and rank sum test. Results There no significant differences in all the indexes of the two groups before delivery were observed （P 〉 0.05 ）. After delivery there was significant difference in the levels of serum total bilirubin, serum creatine, the activity of plasma thromboplastin, the incidence of hepato - renal syndrome, postpartum hemorrhage, puerperal infection and mortality between the two groups （ P 〈 0.05 ） ; there was no significant difference in the levels of serum cholesterol, serum chalinesterase and encepbalopathy between the two groups （ P 〉 0. 05）. Conclusion Caesarean section plus hysterectomy can improve the prognosis of hepatitis gravis in pregnancy.