对米非司酮致早孕合并子宫肌瘤患者腹腔内大出血休克病例临床分析

Clinical analysis of massive intraperitoneal hemorrhagic shock in early pregnancy complicated with myoma caused by mifepristone

目的总结早孕合并子宫肌瘤患者流产诊治过程中的经验及不足。方法本文报道1例早期妊娠合并巨大子宫肌瘤患者,要求终止妊娠。拟药物流产后行辅助清宫术。结果患者仅服用米非司酮第2日突发剧烈下腹痛,腹腔少到中量积液。拟诊“血腹待查:异位妊娠?脾破裂?失血性休克”。纠正休克同时急诊行剖腹探查术。反复探查盆腹腔,未见明显出血点,术中见阴道内极少量积血,绒毛自行排出,予以清宫。最后考虑出血为子宫内出血反流至腹腔所致。结论早孕合并子宫肌瘤属于高危流产范畴,尤其是大于5 cm的子宫肌瘤,此类患者需严格把握药物流产适应证,并加强监护和管理,避免失血性休克等严重并发症。

Objective To analyze and summarize the experience and shortcomings of this case in the process of abortion diagnosis and treatment of early pregnancy patients with hysteromyoma.Methods A case of early pregnancy complicated with huge hysteromyoma was reported.The patient was planned to perform assisted uterine curettage after drug flow.Results On the second day after taking mifepristone,the patient suddenly suffered from severe lower abdominal pain and less to moderate amount of ascites in the abdominal cavity."Blood abdomen to be investigated:ectopic pregnancy?Spleen rupture?Hemorrhagic shock".The shock was corrected and exploratory laparotomy was performed at the same time.Repeated exploration of the pelvis and abdomen revealed no obvious bleeding point.During the operation,a small amount of blood was found in the vagina,and the villi were discharged automatically,so the uterus was cleared.The final consideration was that the bleeding was caused by the backflow of intrauterine bleeding to the abdominal cavity.Conclusion Early pregnancy with hysteromyoma belongs to the category of high-risk abortion,especially hysteromyoma larger than 5 cm.Such patients need to strictly grasp the indications of drug abortion,and strengthen monitoring and management to avoid serious complications such as hemorrhagic shock.