子宫切除在抢救剖宫产产后大出血中的疗效分析

The Report of 21 Cases for Hysterectomy in Treatment of Postpartum Hemorrhage of Cesarean Section

目的：子宫切除术是抢救产后出血有效的措施之一,剖宫产术中大出血时,正确把握子宫切除术的适应证及时机,以抢救孕产妇生命,提高产后出血抢救的成功率。方法：总结我院2006年1月~2011年12月6年期间剖宫产同时行子宫切除术病例共21例,通过回顾性分析,总结出剖宫产同时行子宫切除术原因（适应证）及其手术时机、产妇的预后等。结果：6年间,剖宫产产后出血,术中同时行子宫切除21例,手术适应证：前置胎盘合并胎盘植入12例;胎盘早剥致子宫胎盘卒中、子宫收缩乏力4例;子宫不完全破裂2例,妊娠合并巨大子宫肌瘤、多发性子宫肌瘤2例,剖宫产产后子宫收缩乏力1例。结论：剖宫产术中大出血时,在保守治疗无效的危急情况下,果断进行子宫切除术能抢救产妇生命,从而降低孕产妇死亡率。但同时子宫切除也给育龄妇女的身心健康造成一定的影响。在临床工作中,应及早发现和积极处理产科异常情况,避免病情恶化造成不必要的子宫切除,才能从根本上提高产科质量。但在危急情况下,果断的子宫切除术是抢救产妇生命的最有效方法。

Objective：Hysterectomy is one of effective measures to rescue the postpartum hemorrhage. It can save life and improve the success rate of rescue in cesarean section through hysterectomy in correct time. Methods：we summed up the cesarean section and hysterectomy cause （indication） and operation time, maternal prognosis from 2006 January -2011 year in December for 6 years through a retrospective analysis 21 cases in our hospital. Results：There were 21 cases with postpartum hemorrhage of cesarean section at the same time in 6 years. Operation indications： placenta 12 cases complicated with placenta accreta; placental abruption induced uterine placenta, uterine atony in 4 cases; incomplete rupture of uterus in 2 cases of pregnancy complicated with huge, uterine fibroids, multiple myoma of uterus 2 example, postpartum uterine atony cesarean section in 1 cases.Conclusions：Hysterectomy can rescue of maternal life, thereby reducing the maternal mortality rate in massive hemorrhage in cesarean section. But at the same time the hysterectomy causes certain effect for the health of women in childbearing age . In clinical work, we should be detect early and find active treatment of abnormal obstetric cases, to avoid deterioration as unnecessary hysterectomy in order to fundamentally improve the quality of obstetric. But the decisive hysterectomy is the most effective method to rescue of maternal life in emergency situation.