产科47例子宫切除的临床分析

A clinical analysis of 47 cases of hysterectomy

目的 分析47例子宫切除患者的高危因素,为降低产科子宫切除率提供理论依据。方法 回顾性分析2016年7月至2021年6月于山东第一医科大学附属省立医院产科行子宫切除术的47例患者的临床资料。结果 近5年山东第一医科大学附属省立医院产科子宫切除比例为1.22‰。产后出血依然是子宫切除第一位危险因素(41例),其次为妊娠合并妇科恶性肿瘤(3例)、产褥感染致子宫坏死(2例)、中期妊娠引产后胎盘植入(1例)。产后出血的主要原因为凶险性前置胎盘并植入,占比90.24%(37/41);其次是高龄妊娠合并子宫肌瘤,占比4.88%(2/41);再次为产后宫缩乏力延误治疗,占比2.44%(1/41),及妊娠期急性脂肪肝合并DIC,占比2.44%(1/41)。37例凶险性前置胎盘并植入患者中,19例(51.35%)行子宫次全切术,18例(48.65%)行子宫全切术,子宫次全切患者的平均出血量及输血量少于子宫全切患者,P<0.05;37例凶险性前置胎盘并植入患者中,采取血管介入手术(包括腹主动脉球囊阻断以及髂血管阻断术)的患者占54.05%(20/37),未采用血管介入手术的患者占45.95%(17/37),采取血管介入患者的平均出血量少于未采用血管介入患者,P<0.05。结论 凶险性前置胎盘并植入引起的产后出血是导致子宫切除的最主要原因。对于严重的凶险性前置胎盘并植入案例,采取适当的介入手术,同时结合患者的意愿及年龄,行计划性子宫次全切术可以减少出血量,从而改善患者预后。

Objective To analyze the risk factors so as to provide a theoretical basis for reducing the rate of obstetric hysterectomy.Methods Clinical data of 47 patients undergoing obstetric hysterectomy during July 2016 and June 2021 were retrospectively analyzed.Results In the past 5 years,the rate of hysterectomy in the Obstetric Department of Shandong Provincial Hospital Affiliated to Shandong First Medical University was 1.22‰.Postpartum hemorrhage ranked the first risk factor for hysterectomy(41 cases),followed by pregnancy with gynecological malignant tumors(3 cases),uterine necrosis caused by puerperal infection(2 cases),and placental implantation after induced labor in the second trimester(1 case).The main cause of postpartum hemorrhage was pernicious placenta previa and accreta(90.24%,37/41),followed by advanced pregnancy with giant uterine fibroids(4.88%,2/41),uterine inertia(2.44%,1/41) and pregnancy acute fatty liver with DIC(2.44%,1/41).Among 37 cases of pernicious placenta previa and accreta,19(51.35%) underwent subtotal hysterectomy,and 18(48.65%) total hysterectomy.The average amount of blood loss and blood transfusion in the total hysterectomy cases were higher than those in the subtotal hysterectomy cases(P<0.05).Of the 37 patients with pernicious placenta previa and accreta,54.05%(20/37) received vascular interventional procedures,including abdominal aortic balloon occlusion and iliac vascular occlusion.The average blood loss of the vascular intervention cases was lower than that of the non-vascular intervention cases(P<0.05).Conclusion Postpartum hemorrhage caused by pernicious placenta previa and accreta is the main cause of hysterectomy.For serious and pernicious cases of placenta previa and accreta,appropriate interventional surgery and subtotal hysterectomy can reduce blood loss and improve the prognosis.