围产期急症子宫切除术治疗产后出血30例病例分析

Analysis of 30 Cases of Emergency Peripartum Hysterectomy for the Treatment of Postpartum Hemorrhage

目的探讨产后出血急症子宫切除术治疗的时机、指征及高危因素,以期降低产后出血急症子宫切除的发生率及患者死亡率。方法对本院2000年6月至2008年6月因产后出血行急症子宫切除术的30例病例进行回顾性分析。结果围产期急症子宫切除率为0.18%(30/16546),其中剖宫产组急症子宫切除率为0.24%(24/9900),阴道分娩组急症子宫切除率为0.09%(6/6616),两者对比差异有统计学意义(P<0.05)。30例中有2例死亡(其中1例为羊水栓塞,另1例为多脏器功能障碍综合征),急症子宫切除术治疗后抢救成功率为93.33%。30例产后出血行急症子宫切除术患者原发病因:胎盘因素16例,软产道裂伤4例,宫缩乏力4例,羊水栓塞3例,子宫破裂2例,凝血功能障碍伴多脏器功能受损1例。结论本文胎盘因素是产后出血围产期急症子宫切除术最主要的手术指征。加强前置胎盘、胎盘植入的产前诊断,重视孕产妇管理有望降低围产期急症子宫切除率及孕产妇死亡率。

Objective To explore the indications and risk factors of the emergency peripartum hysterectomy associated postpartum hemorrhage for the purpose of reducing patient mortality and also reduction of the incidence of emergency hysterectomy resulted from postpartum hemorrhage. Method A retrospective study of 30 cases of emergency peripartum hysterectomy resulted from postpartum hemorrhage during 2000-2008 was performed. Result The rate of emergency peripartum hysterectomy was 0.18% （30/16546）, in which the rate of the cesarean was 0.24% （24/9900） and the rate of vaginal delivery was 0.09%（6/6616）,and the difference was significant（P〈0.05）. The survival rate was 93.33% after hysterectomy surgery treatment and two death cases were noted （one died of amniotic fluid embolism, and the another one died of multiple organ dysfunction）. Further analysis revealed that 16 cases involved placental factors, 4 cases had soft birth canal laceration, 4 cases were due to uterine inertia, 3 cases had amniotic fluid embolis, 2 cases had uterine rupture and 1 case of blood coagulation dysfunction associated with multiple organ dysfunction. Conclusion Placental factor is the main indication of emergency peripartum hysterectomy resulted from postpartum hemorrhage. Strengthening of prenatal diagnosis of placenta previa and placenta accreta, and paying attention on maternal perinatal management may reduce the rate of emergency pcripartum hysterectomy.