产后出血致围产期子宫切除患者行再次探查手术的相关研究

The Correlative study on the Reoperation of Patients with Postpartum Hemorrhage Caused by Perinatal Hysterectomy

目的探讨产后出血围产期子宫切除术后再次腹腔探查手术的原因。方法回顾性分析方便选取的该院2014年4月—2016年10月产科收治的40例产后出血致围产期子宫切除病例,其中18例为再次探查手术组,22例为非再次探查手术组。比较2组分娩方式、子宫切除方式、并发症等指标差异。结果再次探查组患者的分娩方式、子宫切除方式与非再次探查组比较,差异无统计学意义(P>0.05);再次探查组患者腹腔出血发生率为66.67%,显著高于非再次探查组的9.09%,差异有统计学意义(P<0.05);再次探查组患者术后感染、DIC、休克、尿潴留发生率分别为11.11%、5.56%、5.56%及11.11%,与非再次探查组比较,均差异无统计学意义(P>0.05)。结论腹腔出血可能是产后出血围产期子宫切除术后再次腹腔探查手术的原因,术中早发现腹腔出血,及时处理手术创伤和其他原因引起的出血,有助于减少患者术后再次行腹腔探查的机率。

Objective This paper tries to investigate the causes and correlations of intraperitoneal exploration after hysterectomy in postpartum hemorrhage.Methods 40 cases of postpartum hemorrhage caused by perinatal hysterectomy in this hospital from April 2014 to October 2016 were convenient selected in this study.Among them,18 cases were in re-examined operation group and 22 cases were in non-re-examined operation group.The delivery mode,hysterectomy,complications and other index of the two groups were compared.Results There was no significant difference in the mode of delivery and hysterectomy betweenre re-examined group and non re-examined group（P〈0.05）.The incidence of abdominal hemorrhage in the re-examined group was 66.67%,significantly higher than the non re-examined group of 9.09%,with statistically significant（P〈0.05）.The postoperative infection,DIC,shock,urinary retentionofre in the re-examined group were 11.11%,5.56%,5.56% and 11.11%,which had no statistical difference with non re-examined group（P〉0.05）.Conclusion Peritoneal hemorrhage is the main cause of intraperitoneal exploration after perinatal hysterectomy in postpartum hemorrhage.The causes of intraperitoneal hemorrhage are found in patients before operation,and the causes of surgical trauma and other causes are observed in time to prevent or decrease the probability of intraperitoneal exploration.