产科急症子宫切除相关因素分析

Analysis of factors related to emergency obstetric uterine resection

目的：了解及探讨产科急症子宫切除术的手术指征及相关危险因素，为降低产科子宫切除的发生率提供基础数据。方法：对2003年1月-2012年12月期间在我院因产科因素采取急症子宫切除术的34例患者的临床资料进行回顾性分析，采用SPSS17．0对数据进行统计分析。结果：急症子宫切除术34例，发生率为0．29％。初产妇发生率为0．092％，经产妇为0．98％。剖宫产术后行子宫切除率为0．65％；阴道分娩后子宫切除率为0．06％，并有统计学差异（X2=34．337，P〈0．01）。产次越多，发生子宫切除率越高（X2=120．54，P〈0．01）。手术指征主要为宫缩乏力15例（占44．2％）、前置胎盘10例（占29．4％）、胎盘早剥6例（17．6％）、羊水栓塞3例（占8．8％）。结论：子宫切除是抢救产科急症出血的重要措施，掌握手术指征，提高手术技巧，是减少及避免产妇子宫切除的关键。

Objective： To understand and explore the operation indications and related risk factors of hysterectomy in the emergency obstetric, in order to reduce the incidence of the obstetric hysterectomy and provide basic data. Methods： Clinical data of 34 patients were analyzed retrospectively in our hospital during the period from 2003 Jan to 2012 Dec by SPSS 17.0 software. Results：There were 34 cases of emergency hysterectomy, and the rate was 0.29%. The rate of paramara was 0.12%, while that of puhipara was 0.86%. The cesarean section rate was 0.65% after hysterectomy, while that after vaginal delivery was 0.06%. There were statistically difference between them （X2 = 34. 337, P 〈0.01 ）. As the production times released, the rate of uterine resection were higher（ X2 = 120.54 ,P 〈0. 01 ）. The indications of operation were 15 cases of uterine atony（44.2% ）, 10 cases of placenta previa（29.4% ）, 6 cases of placental abruption（ 17. 6% ） and 3 cases of amniotic fluid embolism（ 8.8% ）. Conclusion： Uterine resection was an important measure to rescue emergency obstetric hemorrhage. Mastering the indications of operation and improving the operation skills were the keys of reducing and avoiding maternal uterine resection.