李玉梅



急症子宫切除术在PPP并发产后出血者围生期的手术时机

李玉梅

目的探讨凶险性前置胎盘(PPP)并发产后大出血患者围生期行急症子宫切除术的适宜时机。方法以90例围生期行急症子宫切除术的凶险性前置胎盘并发产后大出血患者为研究对象，采用回顾性分析方法进行研究。根据患者行急症子宫切除术时机不同进行分组，对照组为产后立即行子宫切除者43例，观察组为产后经药物止血、宫腔纱布填塞术、子宫动脉结扎术保守治疗无效后行子宫切除术者47例。比较两组子宫切除手术情况及术后恢复情况。结果观察组切除子宫前出血量和总出血量分别为（2962.3±233.8）ml和（5966.9±434.5）ml，多于对照组（2463.5±254.2）ml和（5366.4±454.3）m l（P＜0.05）；观察组新鲜冰冻血浆输注量为（1591.2±145.1）m l，多于对照组（P＜0.05）；两组病死率、并发症发生率、住院时间比较无统计学差异（P＞0.05）。结论与立即行子宫切除相比，以保留子宫为目的的保守治疗失败后再行子宫切除，并未增加凶险性前置胎盘并发产后大出血患者的预后风险，并未明显影响患者术后恢复情况。

凶险性前置胎盘；产后出血；子宫；切除术；手术时机

[Abstract]Objective To investigate the proper operation timing of perinatal emergency hysterectomy for patients with pernicious placenta previa(PPP)complicated with postpartum hemorrhage.Methods 90 patients with PPP complicated with postpartum hemorrhage who received perinatal emergency hysterectomy were chosen as the research objects.Retrospective analysis method was carried out in the research.Those patientswere grouped according to the different time of the operation.Control group(43 cases)accepted hysterectomy immediately after the delivery.Observation group(47 cases)accepted hysterectomy after the failure of conservative treatment(hemostasiswithmedicine,intrauterine gauze filling,and uterine arterial ligation).Comparison wasmade in the operation situations and postoperative recovery between the two groups.Results The total amountof bleeding before the hysterectomy and the total blood loss in the observation group were(2962.3±233.8)m l and(5966.9±434.5)m lwhich weremore than those in the control group[(2463.5±254.2)m l and(5366.4±454.3)ml](P＜0.05).The fresh frozen plasma infusion volume in the observation group were(1591.2±145.1)mlwhich weremore than those in the control group(P＜0.05).Therewere no significant difference in death rate, the incidence of complications,and hospitalization time between the two groups(P＜0.05).Conclusion Compared with the immediate hysterectomy,the hysterectomy after the failure of conservative treatment aiming to preserve the uterus does not increase the prognostic risk of patients with PPP complicated with postpartum hemorrhage and does not significantly affect the postoperative recovery of patients.

[Keywords]pernicious placenta previa;postpartum hemorrhage;uterus;hysterectomy;operation timing

1　资料与方法

1.1病例资料选择2012年1月～2015年1月本科收治的90例凶险性前置胎盘并发产后大出血患者为研究对象，纳入标准：符合凶险性前置胎盘并发产后大出血诊断标准，且有子宫切除指征[3-4]；在剖宫产后围生期行急症子宫切除术；手术和术后恢复情况有详细记录，病例资料完整。根据患者子宫切除时机分为两组，对照组为43例产后立即子宫切除者，年龄25～39（29.4±2.6）岁；……