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目的探讨围产期子宫切除术患者的人口学特征、危险因素及手术指征,总结2009-2013年中国医科大学附属盛京医院围产期子宫切除术的变化特点,为减少子宫切除术发生率和提高产科质量提供依据。方法选取2009-2013年该院所有行围产期子宫切除术的病例为研究对象,对其人口学特征、手术指征和影响因素等临床资料进行回顾性分析。结果 2009年1月-2013年12月该院共有40 804例孕妇分娩,其中行围产期子宫切除术的孕妇62例,发生率为1.52‰。62例患者平均年龄32.9岁,平均产次1.9次,平均分娩孕周34.9周。手术指征包括子宫收缩乏力(16例,25.8%),胎盘病理性着床(35例,56.5%),子宫破裂(3例,4.8%),凝血功能异常(4例,6.5%),妇科疾病(4例,6.5%)。高龄、经产妇、剖宫产术以及早产等为围产期子宫切除术的高危因素(P<0.05)。结论胎盘病理性着床及子宫收缩乏力是围产期子宫切除术发生的主要原因,剖宫产、经产妇分娩、高龄及早产均是围产期子宫切除术发生的高危因素。避免产科子宫切除高危因素,严格控制剖宫产指征是减少围产期子宫切除的关键。
Objective To investigate the demographic characteristics, risk factors and surgical indications of perinatal hysterectomy patients. To summarize the characteristics of perinatal hysterectomy in Shengjing Hospital affiliated to China Medical University from 2009 to 2013, in order to reduce the incidence of hysterectomy And improve the quality of obstetrics provide the basis. Methods From 2009 to 2013, all cases of perinatal hysterectomy in this hospital were selected as the research objects, and their demographic characteristics, surgical indications and influencing factors were retrospectively analyzed. Results From January 2009 to December 2013, a total of 40 804 pregnant women were delivered in this hospital. Among them, 62 pregnant women underwent perineal hysterectomy, with an incidence of 1.52 ‰. 62 patients with an average age of 32.9 years, the average yield of 1.9 times, the average gestational age of 34.9 weeks. Surgical indications included uterine atony (16 cases, 25.8%), placental implantation (35 cases, 56.5%), uterine rupture (3 cases, 4.8%), coagulation abnormalities Disease (4 cases, 6.5%). Elderly, maternal, cesarean section and premature delivery were the risk factors of perinatal hysterectomy (P <0.05). Conclusion Placental pathology implantation and uterine atony are the main causes of perinatal hysterectomy. Cesarean section, maternal delivery, advanced age and premature delivery are both risk factors of perinatal hysterectomy. Avoid obstetrical hysterectomy risk factors, strict control of cesarean section indications is to reduce the key to perinatal hysterectomy.