9例完全性子宫破裂病例病因分析与探讨

Etiological Analysis and Exploration of 9 Cases of Complete Uterine Rupture

目的:探讨完全性子宫破裂的病因、临床特点及结局。方法:回顾性分析2016年1月—2018年12月南京医科大学附属淮安第一医院收治的9例完全性子宫破裂患者的病例资料,对患者一般资料及发病、治疗过程进行归纳总结。结果:9例完全性子宫破裂患者中,引产导致子宫破裂4例(2例位于子宫体部、2例位于子宫下段原切口瘢痕),胎盘植入导致子宫破裂1例(子宫下段原切口瘢痕处),不明原因子宫破裂1例(有人工流产病史,位于子宫底部),腹腔镜宫角部手术后瘢痕破裂1例(位于子宫角部),宫缩发动后前次剖宫产瘢痕切口破裂2例(子宫下段原切口瘢痕处)。临床表现为持续性下腹痛2例,不规则下腹痛4例,持续性脐周痛1例,无明显腹痛2例。6例伴阴道出血,3例无阴道出血表现。7例行子宫破裂修补术,2例行次全子宫切除术。非引产的5例病例中,胎死宫内1例,其余4例新生儿结局良好。结论:瘢痕子宫再次妊娠是子宫破裂的高发人群,对于具有前置胎盘、多次剖宫产和人工流产、子宫手术等宫腔操作史的孕妇应警惕子宫破裂的风险。

Objective: To investigate the etiology, clinical characteristics and outcome of complete uterine rupture. Methods: A retrospective analysis was performed on the case data of 9 patients with complete uterine rupture admitted to the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University from 2016 to 2018, and the general information and treatment process of the patients were summarized. Results: Nine patients with complete uterine rupture: Induced labor caused 4 cases of uterine rupture(2 cases were in the uterine body and 2 cases were in the original incision scar of the lower uterine segment), and placental implantation caused 1 case of uterine rupture (in the lower portion of the original incision scar). 1 case of unexplained uterine rupture(with a history of induced abortion, located at the bottom of the uterus) and one case of scar rupture after laparoscopic corner surgery (located at the uterine corner). Two cases of previous cesarean section scar incision rupture after uterine contraction (the original incision scar in the lower uterus). Two cases had persistent lower abdominal pain, 4 cases had irregular lower abdominal pain, 1 case had persistent umbilical pain, and 2 cases didn't have obvious abdominal pain. There were 6 cases with vaginal bleeding, and 3 cases without. Seven patients underwent uterine rupture repair and two underwent total hysterectomy. Of the 5 non-labored cases, 1 case of intrauterine fetal death, and the remaining 4 cases had good neonatal outcomes. Conclusions: Scarred uterus re-pregnancy is a high incidence of uterine rupture. Pregnant women with a history of uterine cavity operations such as placenta previa, multiple cesarean sections and abortions, and uterine surgery should be alert to the risk of uterine rupture.