全子宫切除术后阴道残端出血临床分析

目的回顾性分析全子宫切除术后阴道残端出血的临床诊治措施。方法 2009年3月～2010年4月某院收治的76例子宫肌瘤患者,随机分为对照组及观察组,每组38例,两组患者均实施常规全子宫切除术,观察组在此基础上实施阴道断端及盆腔腹膜缝合及术后处理,观察阴道残端出血情况、阴道残端局部情况。结果对照组术后24h内出血1例,术后24h～10d内出血24例,术后10d以上后出血3例,24h～10d内出血最多,占63.2%,且显著多于观察组21.1%(P﹤0.05);对照组轻度出血16例,中度出血10例,重度出血2例,轻度出血最多,占42.1%,且显著多于观察组18.4%,所有患者均无肉芽组织生长。对照组11例(占28.9%)为肠线吸收不良,9例(23.7%)为肠线脱落,5例(13.2%)为肠线套松驰,1例(2.6%)为表面充血或呈污秽色,1例(2.6%)为缝合过稀,1例(2.6%)为阴道断端右侧角部血管漏扎,其中前3项百分比显著高于观察组(P值均﹤0.05)。结论针对全子宫切除术患者实施有效措施,可显著减少阴道残端出血的发生率,有助于术后康复,有效避免宫颈残端癌的发生。

Clinical analysis for Hysterectomy vaginal stump hemorrhage

OBJECTIVE To retrospectively analyzfe the clinical diagnosis and treatment measures for nhysterectomy following vaginal stump hemorrhage. METHODS 76 subjects with uterine fibroids were collected from March 2009 to April 2010, and they were randomly divided into control group and observation group, 38 cases in each group. The two groups were implemented in routine hysterectomy. The observation group taken pelvic peritoneal sutures and postoperative treatment after performing vaginal cuff. Then we observed the vaginal stump end of bleeding and vaginal stump local circumstance. RESULTS In the control group, 1 case showed 24h postoperative hemorrhage, 24 cases showed 24h-10d postoperative hemorrhage, 3 cases showed postoperative bleeding after 10d, 24h-10d hemorrhage accounted for 63.2% of the patients, and was significantly higher than that of the observation group (21.1%)(P﹤0.05); 16 cases showed mild hemorrhage in the control group, 10 cases showed moderate hemorrhage, 2 cases showed severe bleeding, mild hemorrhage accounted for 42.1% , and was significantly higher than that of the observation group (18.4%). All patients had no growth of granulation tissue, 11 cases showed gut malabsorption in the control group (28.9%), 9 cases (23.7%) showed catgut shedding, 5 cases (13.2%) showed catgut set relaxation, 1 case (2.6%) showed surface hyperemia or dirty color, 1 case (2.6%) showed thin stitching, 1 case (2.6%) showed right corner vascular leakage tie after vaginal cuff, and the percentage of gut malabsorption, catgut shedding and catgut set relaxation were significantly higher than those in the observation group (P﹤0.05). CONCLUSION Effective measures for patients with hysterectomy, can significantly reduce the vaginal stump hemorrhage rate, contribute to postoperative rehabilitation, effectively avoid the occurrence of cervical stump carcinoma.