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患者24岁,G_1P_1孕39周因“头盆不称”在外院行剖腹产术,术后阴道恶露淋沥近50日,未诊。术后第55日、即1992年12月25日突然无故无痛阴道大出血休克于外院就诊,止血1周。1993年元月10日又发生阴道大出血,急诊入我院。查:T36.8℃,P 90次/分,BP14/8kPa,面色稍差。妇检:子宫后位,如孕6~+周大小,未触及痛性结节,双附件(-),宫颈光滑,WBC9.6×10~9/L,RBC2.9×10~(12)/L,Hb 90g/L,即予静脉补液加止血药、宫缩剂及抗生素等,经处理出血减少,交叉配血未输血,约5小时后再次阴道大出血,迅即休克,排出一团似组织样物(后病理报告为血块与宫内膜),经抗休克处理,即在做好全宫切除剖腹探查术准备后行诊刮术,刮出组织2g,当晚无法行冰冻切片检查,2日后病理报告为增殖期宫内膜。B超示宫腔内未见占位性病变。继续留治,止血5日,于1993年元月24日再次发生阴道大流血休克,20分钟内出血达1300ml,经颈静脉切开快速输血,边抗休克边剖腹探查;术中分离膀胱腹膜反折发现原子宫下段切口中段及右下角有1.5×1cm裂孔,表面附着坏死组织,即行全宫切除术。术后抗炎支持疗法1
Patients 24 years of age, G_1P_1 39 weeks of gestation due to “cephalopelvic disproportion” Caesarean section outside the hospital, postoperative vaginal discharge dew leaking nearly 50 days, not diagnosed. After the first 55 days, that is, December 25, 1992 sudden painless vaginal bleeding for no reason outside the hospital, stop bleeding for 1 week. On January 10, 1993, another vaginal bleeding occurred again. The emergency department was admitted to our hospital. Check: T36.8 ℃, P 90 beats / min, BP14 / 8kPa, looking slightly worse. Gynecological examination: posterior uterus, such as pregnancy 6 ~ + weeks size, no painful nodules, double attachment (-), smooth cervix, WBC9.6 × 10 ~ 9 / L, RBC2.9 × 10 ~ (12) / L, Hb 90g / L, that is, to the intravenous rehydration plus hemostatic agents, uterine contractions and antibiotics, the bleeding was reduced cross-blood with blood transfusions, about 5 hours after vaginal bleeding again, quickly shock, a mass of tissue Samples (posterior pathology report for the blood clots and endometrium), after anti-shock treatment, that is doing a total hysterectomy exploratory laparotomy curettage, scraping tissue 2g, the night can not be frozen section examination, 2 days later Pathological report of proliferative endometrium. B ultrasound showed no occupying lesions in the uterine cavity. Continue to treat, stop bleeding on the 5th, again in January 19, 1993 vaginal bleeding in shock, bleeding within 20 minutes up to 1300ml, fast transfusion through the jugular vein, anti-shock while laparotomy exploration; intraoperative separation of the peritoneal bladder reflex Found that the lower uterine segment incision in the middle and lower right corner of 1.5 × 1cm hole, necrotic tissue attached to the surface, that is, hysterectomy. Postoperative anti-inflammatory supportive therapy 1