急症子宫切除术在PPP并发产后出血者围生期的手术时机

Operation timing of perinatal emergency hysterectomy for patients with pernicious placenta previa complicated with postpartum hemorrhage

目的探讨凶险性前置胎盘(PPP)并发产后大出血患者围生期行急症子宫切除术的适宜时机。方法以90例围生期行急症子宫切除术的凶险性前置胎盘并发产后大出血患者为研究对象,采用回顾性分析方法进行研究。根据患者行急症子宫切除术时机不同进行分组,对照组为产后立即行子宫切除者43例,观察组为产后经药物止血、宫腔纱布填塞术、子宫动脉结扎术保守治疗无效后行子宫切除术者47例。比较两组子宫切除手术情况及术后恢复情况。结果观察组切除子宫前出血量和总出血量分别为(2962.3±233.8)ml和(5966.9±434.5)ml,多于对照组(2463.5±254.2)ml和(5366.4±454.3)ml(P<0.05);观察组新鲜冰冻血浆输注量为(1591.2±145.1)ml,多于对照组(P<0.05);两组病死率、并发症发生率、住院时间比较无统计学差异(P>0.05)。结论与立即行子宫切除相比,以保留子宫为目的的保守治疗失败后再行子宫切除,并未增加凶险性前置胎盘并发产后大出血患者的预后风险,并未明显影响患者术后恢复情况。

Objective To investigate the proper operation timing of perinatal emergency hysterectomy for patients with pernicious placenta previa（PPP） complicated with postpartum hemorrhage. Methods 90 patients with PPP complicated with postpartum hemorrhage who received perinatal emergency hysterectomy were chosen as the research objects. Retrospective analysis method was carried out in the research. Those patients were grouped according to the different time of the operation. Control group（43cases） accepted hysterectomy immediately after the delivery. Observation group（47 cases） accepted hysterectomy after the failure of conservative treatment（hemostasis with medicine, intrauterine gauze filling, and uterine arterial ligation）. Comparison was made in the operation situations and postoperative recovery between the two groups. Results The total amount of bleeding before the hysterectomy and the total blood loss in the observation group were（2962.3±233.8） ml and（5966.9±434.5） ml which were more than those in the control group [（2463.5±254.2） ml and（5366.4±454.3） ml]（P 〈 0.05）. The fresh frozen plasma infusion volume in the observation group were（1591.2±145.1） ml which were more than those in the control group（P 〈 0.05）. There were no significant difference in death rate,the incidence of complications, and hospitalization time between the two groups（P 〈 0.05）. Conclusion Compared with the immediate hysterectomy, the hysterectomy after the failure of conservative treatment aiming to preserve the uterus does not increase the prognostic risk of patients with PPP complicated with postpartum hemorrhage and does not significantly affect the postoperative recovery of patients.