凶险性前置胎盘产后大出血患者子宫切除术的最佳时机选择

The Best Time of Hysterectomy for Dangerous Placenta Praevia with Postpartum Hemorrhage

目的:探讨凶险性前置胎盘产后大出血患者子宫切除术的最佳时机。方法:选取笔者所在科室2014年3月-2017年3月收治的90例凶险性前置胎盘产后大出血患者,按照手术时机的不同分为观察组28例和对照组62例。对照组在剖宫产后立即切除子宫,观察组经保守治疗无效后行子宫切除术。比较两组手术出血量、输血情况及术后恢复情况。结果:观察组切除术前出血量、总出血量均多于对照组,新鲜冰冻血浆输注量多于对照组,差异有统计学意义(P<0.05)。两组的血细胞悬液输注量、全血输注量及凝血酶原复合物输注量比较差异无统计学意义(P>0.05)。两组术后抗生素使用时间、术后下床活动时间、住院时间、并发症发生率比较,差异均无统计学意义(P>0.05)。结论:凶险性前置胎盘产后大出血可经保守治疗无效后再行子宫切除,其不会增加患者的风险,还有可能为患者保留生育功能。

Objective：To explore the best time of hysterectomy for dangerous placenta praevia with postpartum hemorrhage.Method：90 cases of dangerous placenta praevia with postpartum hemorrhage in our department from March 2014 to March 2017 were divided into the observation group（28 cases） and the control group（62 cases） according to the timing of operation.The control group was given hysterectomy immediately after cesarean section,and the observation group was given hysterectomy after the conservative treatment was not effective.The amount of bleeding blood transfusion and recovery after operation were compared between the two groups.Result：the bleeding volume and total bleeding volume in the observation group were all higher than those in the control group,the amount of fresh frozen plasma infusion in the observation group was more than that in the control group,and the difference was statistically significant（P〈0.05）.There was no significant difference between the two groups in blood cell suspension infusion,total blood infusion and prothrombin complex infusion（P〈0.05）.There was no statistical significance between the two groups in the time of use of antibiotics,the time of ambulation after operation the time of hospitalization and the complications（P〈0.05）.Conclusion：Dangerous placenta previa with postpartum hemorrhage can be treated by hysterectomy without effective conservative treatment.It will not increase the risk of patients,and may also preserve fertility for patients.