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目的探讨产科急症子宫切除术临床特点及处理方法。方法选取的患者50例中,保守治疗效果不佳,开腹实施子宫切除术13例;剖宫产时实施子宫切除28例;晚期产后出血,行子宫切除9例。其中子宫次全切除术33例,子宫全切术17例。手术结束后,取抗生素常规抗感染。结果本次次全子宫切除率为66%,全子宫切除率为34%。分析手术指征,胎盘早剥23例,占46%;胎盘粘连3例,占6%;子宫破裂5例,占10%;晚期产后出血5例,占10%;宫缩乏力14例,占28%。本组多功能脏器损害3例,占6%,无死亡或创口感染病例。手术指征中,胎盘早剥排第一,宫缩乏力居其次。结论产科急症子宫切除是抢救产后出血的重要手段,把握手术指征、手术方式、手术时间,对保证患者生活质量、挽救生命意义重大。故产科医师判断力需专业,有效选择子宫切除术方式和时机,以对生命挽救,保障患者生存质量。
Objective To investigate the clinical features and treatment of obstetric emergency hysterectomy. Among the 50 patients selected by this method, conservative treatment was ineffective. Thirteen patients underwent open hysterectomy; 28 underwent hysterectomy during cesarean section; and 9 patients underwent hysterectomy after advanced postpartum hemorrhage. There were 33 cases of subtotal hysterectomy and 17 cases of hysterectomy. After surgery, antibiotics routine anti-infection. Results The total hysterectomy rate was 66%, hysterectomy rate was 34%. Analysis of surgical indications, placental abruption in 23 cases, accounting for 46%; 3 cases of placental adhesion, accounting for 6%; 5 cases of uterine rupture, accounting for 10%; late postpartum hemorrhage in 5 cases, accounting for 10%; uterine inertia in 14 cases, accounting for 28%. This group of multifunctional organs damage in 3 cases, 6%, no death or wound infection. Surgical indications, ranked first placental abruption, uterine inertia ranks second. Conclusion Obstetric emergency hysterectomy is an important means to rescue postpartum hemorrhage. To grasp the indications, operation methods and operation time is of great significance to ensure the quality of life and save lives. Therefore obstetrician needs a professional judgment, the effective choice of hysterectomy methods and timing to save lives and protect the quality of life of patients.