产科大出血全子宫切除术临床探讨(附12例报告)

目的：探讨产科大出血全子宫切除术在临床中的价值及并发症防治方法。方法：用回顾性分析的方法对12例产科子宫切除术患者的临床资料进行分析。结果：15073例产妇中有12例均经保守治疗不能控制的产科大出血患者实施了急症子宫全切除术，其中阴道分娩后发生率为0．05％。剖宫产后为0．12％，合并DIC者占42％。术后并发症为残端出血，尿路感染，腹部切口愈合不良和下肢深部静脉血栓。远期并发症为性功能下降，围绝经期症状。12例患者均痊愈出院。结论：急性子宫全切除术是抢救产科急重症出血，降低孕产妇病死率的重要措施；但对各种并发症，应高度重视，积极治疗，提高患者术后生活质量。

Clinical study of complete hysterectomy on severe postpartum hemorrhage

Objective:To investigate the clinical value of complete hysterectomy on arresting severe postpartum hemorrhage, and the prevention and treatment methods of its complications. Methods:A retrospective analysis was performed on 12 cases of hysterectomy by reason of postpartum hemorrhage in our hospital from Jan 1993 to May 2004. Results:Among 15073 parturition cases, there were 12 cases of hysterectomy for the reason of severe postpartum hemorrhage that couldn't be controlled by conservative treatment. The incidence was 0.05% in natural birth cases and 0.12% in Caesarean birth cases, and 42% of the cases complicated with DIC (disseminated intravascular coagulation). Postoperative complication include residual end bleeding, urinary tract infection, delayed incision healing and deep vein thrombosis of the lower limps. The chronic complications include hyposexuality and peri-menopause syndrom. All the 12 patients recovered. Conclusion:Emergent complete hysterectomy is one of the effective methods on arresting severe postpartum hemorrhage,which could significantly decrease the meternal mortality. However, special attention should be paid in complication prevention and management,active treatment are keys points to improve patients' living quality.