剖宫产术后巨大阔韧带合并腹膜后血肿3例的临床处置

3 cases of giant broad ligament with retroperitoneal hematoma after cesarean section and related literature review

目的探讨剖宫产术后并发阔韧带和/或腹膜后血肿的临床表现、诊断、治疗及预防。方法回顾性分析珠海市第二人民医院3例剖宫产术后并发巨大阔韧带和腹膜后血肿的临床表现及辅助检查、治疗经过及预后。结果3例患者年龄28～36岁,因头盆不称和/或疤痕子宫行剖宫产,术后2～6 h出现心慌、头晕、腹胀、腹痛、面色苍白、皮肤湿冷、血压下降、脉搏快而细、尿量减少,腹腔抽出不凝血或B超探及腹盆腔血肿行剖腹探查术,术中均见巨大阔韧带和腹膜后血肿,清理游离积血块,缝扎出血点,置盆腔引流管,术后给予支持、抗感染、理疗或中药治疗,腹部包块逐渐缩小,至术后1月余消失。结论剖宫产术后阔韧带、腹膜后血肿应及早开腹行出血点缝扎,血肿腔给予引流,无需完全清除血肿,术后给予理疗及抗感染治疗,疗效良好。

Objective To investigate the clinical manifestations, diagnosis, treatment and prevention of wide ligament and/ or retroperitoneal hematoma after cesarean section. Methods The case data of clinical manifestations and accessory examination, treatment process, prognosis of 3 clinical cases in our hospital with huge hematoma of broad ligament and / or peritoneum after cesarean section were analyzed retrospectively. Results The patients were 28-36 years old and cesarean sections were performed as of cephalopelvic disproportion and uterine scar. 2-6 hours after surgery, due to palpitation, dizziness, abdominal distension, abdominal pain, pale and clammy skin, decreased blood pressure, fast and fine pulse, reduced amount of urine, abdominal uncoagulable blood or B-ultrasound examination showing abdominal pelvic hematoma, the patients underwent laparotomy. Huge hematomas were seen in the broad ligament and peritoneum. Treatments included removing blood clots, placing peritoneal drainage tube, and postoperative supporting symptomatic treatment, anti-infection, physical therapy or traditional Chinese medicine treatment. Results showed that the abdominal mass decreased gradually and disappeared 1 month more after surgery. Conclusion Hematoma of broad ligament and peritoneum after cesarean section could be treated with suturing bleeding, drainage of hematoma cavity and no need to complete removal of the hematoma, physiotherapy and anti-infection treatment after surgery, which produced a good curative effect.