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目的探讨输卵管切除术后患者妊娠期间发生子宫破裂的高危因素、临床表现及预后情况。方法对北京大学第一医院妇产科2015年4月至7月2例曾行输卵管切除术患者妊娠期间发生子宫破裂的病例结合文献进行回顾,分析曾行输卵管切除术而无子宫畸形的宫内妊娠患者,妊娠期间发生子宫破裂的高危因素、临床表现及预后情况。结果本文及既往文献共报道8例曾行输卵管切除术患者妊娠期间发生子宫破裂。其中4例既往为子宫间质部妊娠,行宫角切除;5例腹腔镜手术患者中,4例仅电凝而未行局部缝合;5例患者输卵管切除术后1年内妊娠;4例患者发生子宫破裂时无明显腹痛等临床表现;4例发生胎儿死亡;无孕产妇死亡。结论曾进行输卵管切除的患者,妊娠期间存在子宫破裂的风险。对有妊娠需求的育龄期女性,在进行输卵管切除时,应严格掌握手术指征并慎重选择术式。
Objective To investigate the risk factors, clinical manifestations and prognosis of uterine rupture during pregnancy after tubal resection. Methods The cases of uterine rupture during pregnancy in 2 patients who underwent tubal resection from April 2015 to July 2015 in Peking University First Hospital were retrospectively reviewed and the intrauterine resources of patients who underwent tubal resection without uterine malformation Pregnant patients, risk factors for uterine rupture during pregnancy, clinical manifestations and prognosis. Results This and previous articles reported 8 cases of uterine rupture during pregnancy. Of the 4 patients, 5 had laparoscopic gastrectomy, 4 had only partial coagulation without local suture, 5 had pregnancy within 1 year after tubal resection, and 4 had uterus No obvious abdominal pain and other clinical manifestations of rupture; 4 cases of fetal deaths; no maternal deaths. Conclusions Patients who had tubal resection had a risk of uterine rupture during pregnancy. Women of childbearing age who have pregnancy needs, during tubal resection, surgical indications should be strictly controlled and carefully selected surgical procedures.