产科急诊子宫切除术后再次腹腔探查10例分析

Analysis of 10 cases of abdominal surgical exploration after obstetric emergency hysterectomy

目的探讨产科急诊子宫切除术后再次腹腔探查术的原因及术中注意事项。方法采用回顾性研究方法对2009年1月至2015年12月运城市中心医院收治的10例产科急诊子宫切除术后再次腹腔探查术患者的临床资料进行分析。结果 7年间运城市中心医院因难治性产后出血子宫切除9例,外院因产后出血在当地行子宫切除43例。52例子宫切除患者中再次腹腔探查术10例,发生率19.2%。10例患者均因外院产科急诊行子宫切除后伴失血性休克转入运城市中心医院,其中2例膀胱损伤,2例中有1例合并输尿管损伤。10例剖腹探查手术盆腹腔积血中位数为4450 m L（2100～6300 m L）,总出血量中位数为13 700 m L（9600～20 900 m L）,入院时血红蛋白中位数45 g/L（38～61 g/L）,输注红细胞中位数为44.5 U（32～66 U）。术后急性肾功能衰竭5例,多器官功能障碍综合征（MODS）3例,术后感染3例,盆腔血肿7例,住院治疗9例痊愈,1例死亡。结论产科急诊子宫切除术后再次腹腔探查术的主要原因是首次手术止血不彻底,术后瘪陷的末梢循环恢复血管扩张,凝血功能障碍未能有效控制。

Objective To analyze the causes and intraoperative considerations of abdominal surgical exploration after obstetric emergency hysterectomy.Methods Analyze the clinical data of 10 cases of abdominal surgical exploration after emergency hysterectomy in Yuncheng Central Hospital from January 2009 to December 2015.Results In 7 years there were 9 cases of uterine resection because of intractable postpartum hemorrhage in our hospital,43 cases of uterine resection due to postpartum hemorrhage in local hospital,and 10 cases of abdominal surgical exploration in 52 cases of hysterectomy,the incidence rate being 19.2%.Ten patients were transferred to our hospital because of emergency uterine resection with hemorrhagic shock in the local hospital,including 2 cases of bladder injury,and one of them was with ureter injury at the same time.In the 10 cases of exploration hemoperitoneum median was 4450 m L（2100~6300 m L）,the median of total hemorrhage volume was 13 700 m L（9600~20 900 m L）,at hemoglobin median admission was 45 g/L（38~61 g/L）,and the median transfusion of the red cell was 44.5 U（32~66 U）.There were 5 cases of postoperative acute renal failure,3 cases of MODS,3 cases of postoperative infection,and 7 cases of pelvic hematoma.After hospitalization there were 9 cases of recovery and 1 case of death.Conclusion The main reason of abdominal surgical exploration after obstetric emergency hysterectomy is that hemostasis is not complete after the first operation,the shriveled peripheral circulation has vasodilation after operation and the blood coagulation dysfunction has not be controlled effectively.