瘢痕子宫所致完全性子宫破裂的诊治分析

目的探讨完全性子宫破裂的临床表现、诊治经过、母婴结局以及危险因素以提高临床重视。方法回顾性分析2015年1月至2021年1月杭州市第一人民医院产科收治的完全性子宫破裂患者9例,收集患者的一般资料、临床表现、处理方法、术中情况、母婴结局等进行归纳分析。结果9例完全性子宫破裂患者,1例为TOLAC过程中子宫原瘢痕破裂,1例为宫角部妊娠子宫破裂,7例为孕期自发性子宫破裂。孕期自发性子宫破裂中5例有异位妊娠腹腔镜手术史、1例有多次宫腔操作史、1例有腹腔镜子宫肌瘤剥除手术史。9例患者均保留子宫,治疗康复后出院;5例胎儿存活,2例胎死宫内,2例无生机儿。结论既往存在妇科微创手术史的“瘢痕子宫”孕妇群体容易在孕中期发生自发性子宫破裂,多数有剧烈腹痛、休克等典型症状,母婴预后结局更差,一经确诊,需立即手术。

Objective To investigate the clinical manifestations,diagnosis and treatment,maternal and infant outcomes and risk factors of complete uterine rupture to improve clinical attention.Methods A retrospective analysis was performed on 9 patients with complete uterine rupture admitted to the Department of Obstetrics of Hangzhou First People's Hospital from January 2015 to January 2021.The general information,clinical manifestations,treatment methods,intraoperative conditions and maternal and infant outcomes of all patients were collected and analyzed.Results There were 9 cases of complete uterine rupture,including one case of original uterine scar rupture during TOLAC,one case of uterine rupture during angular pregnancy,and 7 cases of spontaneous uterine rupture during pregnancy.Among the spontaneous uterine rupture during pregnancy,5 cases had a history of laparoscopic surgery for ectopic pregnancy,one case had a history of multiple intrauterine operations,and one case had a history of laparoscopic hysteromyoma removal.All 9 patients retained their uterus and were discharged after treatment and recovery.Five fetuses were alive,two were dead in utero,and two were lifeless.Conclusion The pregnant women with scar uterus with a history of minimally invasive gynecological surgery are prone to spontaneous uterine rupture in the second trimester,most of which have typical symptoms such as severe abdominal pain and shock,and the maternal and infant prognosis is worse.Once confirmed,immediate surgery is required.