产科急症子宫切除58例临床分析

Clinical analysis of emergency obstetric hysterectomy in 58 cases

目的探讨产科急症子宫切除的发生率及相关高危因素。方法选择北京妇产医院近12年间分娩总数126 959例,回顾性分析其中58例急症子宫切除术病例的临床资料。结果行产科急症子宫切除术的病例占分娩总数的0.046%,其中阴道分娩11例,剖宫产47例。手术指征中胎盘因素占44.83%,其中20例(76.92%)因剖宫产史合并胎盘异常。其次为子宫收缩乏力(32.76%)。产科急症子宫切除与分娩次数、分娩方式、剖宫产史、孕周、多胎妊娠显著相关(x～2值分别为151.785、22.568、200.694、114.547、37.084,均P<0.01)。结论产科急症子宫切除术是挽救孕产妇生命的有效手段,应严格掌握剖宫产指征,降低剖宫产率,可减少产科急症子宫切除率。

Objective To investigate the incidence and high risk factors of emergency obstetric hysterectomy .Methods A retrospective study was conducted on the clinical data of 58 pregnant women with emergency obstetric hysterectomy during 12 years in Beijing Obstetrics and Gynecology Hospital with total 126 959 deliveries .Results Totally 58 cases of emergency obstetric hysterectomy occurred among 126 959 deliveries, with the rate of 0.46 per 1000, including 11cases of vaginal delivery and 47 cases of cesarean section .Among surgery indicators, placenta factor occupied 44.83%, and 76.92%of which （20 cases） were cesarean section complicated with placenta factor . The second reason was uterine atony （32.76%）.Emergency obstetric hysterectomy was remarkably correlated with parity , mode of delivery, previous cesarean delivery , gestational age and multiplegestation （χ^2 value was 151.785, 22.568, 200.694, 114.547 and 37.084, respectively, all P〈0.01）.Conclusion Emergency obstetric hysterectomy is an effective method for pregnant women .Strictly controlling the indications of cesarean section and reducing cesarean section rate can reduce the incidence of emergency obstetric hysterectomy .