中央性前置胎盘围产期急症子宫切除术18例分析

目的:探讨中央性前置胎盘患者并发产后大出血行围产期急症子宫切除术的高危因素、手术时机及并发症。方法:回顾性分析四川大学华西第二医院产科2005年1月～2009年12月收治的454例中央性前置胎盘患者的临床资料,其中有18例行急症子宫切除术。结果:①该院近5年来中央性前置胎盘的发生率为1.95%(454/23 279),中央性前置胎盘患者行急症子宫切除术的发生率为3.96%(18/454)。②中央性前置胎盘患者行急症子宫切除术的高危因素包括:经产妇、既往剖宫产史、合并胎盘粘连或植入。③18例中央性前置胎盘患者在切除子宫前的平均出血量为2 969.71 ml。④中央性前置胎盘患者行急症子宫切除组术中出血量、输血率和输注红细胞悬液量、手术时间、术后抗生素应用时间、术后住院时间及新生儿窒息发生率均显著大于未行急症子宫切除组(P<0.05)。结论:应充分认识中央性前置胎盘患者行围产期急症子宫切除的高危因素,重视围手术期的处理,正确掌握子宫切除的手术时机。

Analysis on 18 cases with complete placenta praevia undergoing emergent uterectomy during perinatal period

Objective:To explore the high risk factors,operation opportunity,and complications of emergent uterectomy during perinatal period for the patients with complete placenta praevia combined with postpartum hemorrhage.Methods:The clinical data of 454 patients with complete placenta praevia who were treated in the hospital from January 2005 to December 2009 were analyzed retrospectively,including 18 patients undergoing emergent uterectomy.Results:The incidence of complete placenta praevia was 1.95%(454/23 279) from January 2005 to December 2009,the incidence of emergent uterectomy among the patients with complete placenta praevia was 3.96%(18/454).The high risk factors of emergent uterectomy among the patients with complete placenta praevia included multipara,previous history of cesarean section,combined with placental adhesion or placenta accreta.The average amount of blood loss before uterectomy was 2 969.71 ml.The amount of blood loss during operation,the rate of blood transfusion,the amount of suspension of red blood cells transfusion,operation time,administration time of antibiotics after operation,hospitalization time after operation,the incidence of neonatal asphyxia in emergent uterectomy group were significantly higher than those in non-emergent uterectomy group(P<0.05).Conclusion:The high risk factors of emergent uterectomy during perinatal period for the patients with complete placenta praevia should be emphasized,more attention should be paid to the treatment during perioperative period,the operation opportunity of uterectomy should be grasped correctly.