产科因素致子宫切除术82例临床分析

发布时间：2018-04-14 20:11

本文选题：子宫切除 + 相关因素　；参考：《吉林大学》2014年硕士论文

【摘要】：产科子宫切除术是治疗产科难于控制的出血，挽救孕产妇生命的重要手段及措施。随着近年来剖宫产率的不断增加，妊娠并发症及合并症的增多，增加了产科子宫切除的几率。随着产后出血保守治疗方法的不断改进，，如何避免产科子宫切除仍需要进一步研究。目的：探讨导致产科子宫切除的相关因素。方法：1、回顾性分析2004年1月至2013年12月吉林大学第二临床医院收治的82孕产妇行子宫切除的患者病历资料。病历资料包括：年龄、孕周、孕产史、孕期情况（有无并发症及合并症）、分娩方式、产后出血量、保守治疗方法、母儿结局。分析其发病率、期待治疗方法、术中出血情况及处理方法、对孕妇及胎儿的影响。 2、将数据采用SPSS17.0统计学软件进行统计学处理，采用t检验和2检验进行分析。结果：调查中82例子宫切除患者中，行全子宫切除术25例，次全子宫切除术57例。外院分娩后转入我院行子宫切除术19例，我院分娩后行子宫切除术63例。其中25例因前置胎盘合并胎盘植入行子宫切除术，14例因宫缩乏力行子宫切除术，前置胎盘及子宫破裂因素切除子宫各8例，胎盘植入因素7例，胎盘早剥6例，子宫切口感染5例，妊娠合并血液病、妊娠合并子宫肌瘤、妊娠合并重症肝病各3例。57例有人工流产史，36例既往有剖宫产手术史。82例患者中正常分娩6例，剖宫产术终止妊娠76例。本研究的82例患者无一人死亡。将82例分娩后行子宫切除的原因进行单因素分析，其中胎盘因素（前置胎盘、胎盘植入、胎盘早剥）、宫缩乏力、剖宫产史有统计学意义(P0.05)。结论：孕产妇子宫切除术是治疗产后不可控制大出血，挽救孕产妇生命的有效措施之一。孕产妇子宫切除与胎盘因素、宫缩乏力、剖宫产史有关。其中胎盘因素与多次人工流产史、剖宫产史密切相关，并随剖宫产率增加而呈逐年上升趋势。减少孕产次，做好计划生育和孕产期保健工作，做到早期预防。加大宣传正常分娩好处的相关力度。正确掌握剖宫产的手术指征，从而降低前置胎盘、胎盘植入及子宫破裂的发生率，进而降低孕产妇子宫切除的发生率。
[Abstract]:Obstetrical hysterectomy is an important measure to treat the bleeding which is difficult to control in obstetrics and to save the life of pregnant and parturient.With the increasing rate of cesarean section and the increase of complications and complications of pregnancy, the probability of obstetrical hysterectomy has been increased.With the continuous improvement of conservative treatment of postpartum hemorrhage, how to avoid obstetrical hysterectomy still needs further study.Objective: to explore the related factors of obstetrical hysterectomy.Methods from January 2004 to December 2013, the medical records of 82 pregnant women undergoing hysterectomy in the second Clinical Hospital of Jilin University were retrospectively analyzed.Medical records include age, gestational age, gestational history, pregnancy (complications and complications, delivery, postpartum bleeding, conservative treatment, and maternal and fetal outcomes).The incidence, expectant treatment, intraoperative bleeding and treatment were analyzed, and the effects on pregnant women and fetuses were analyzed.2. The data were processed by SPSS17.0 software and analyzed by t test and 2 test.Results: total hysterectomy and subtotal hysterectomy were performed in 25 cases and 57 cases respectively.19 cases underwent hysterectomy after delivery in our hospital and 63 cases underwent hysterectomy after delivery in our hospital.Among them, 14 cases underwent hysterectomy because of placenta previa and placenta accreta, 8 cases of placenta previa and uterine rupture, 7 cases of placenta accreta, 6 cases of placental abruption, 14 cases of hysterectomy, 8 cases of placenta previa and uterine rupture, 7 cases of placenta accreta, 6 cases of placental abruption.There were 5 cases of uterine incision infection, 6 cases of pregnancy complicated with hematologic diseases, 3 cases of pregnancy with hysteromyoma, 3 cases of severe liver diseases, 3 cases of induced abortion, 36 cases of history of cesarean section and 6 cases of normal delivery.76 cases of pregnancy terminated by cesarean section.None of the 82 patients in this study died.The causes of hysterectomy after delivery were analyzed by univariate analysis. Placental factors (placenta previa, placenta accreta, placental abruption, uterine inertia and history of cesarean section) were statistically significant.Conclusion: hysterectomy is one of the effective measures to treat uncontrollable postpartum hemorrhage and save maternal life.Hysterectomy was associated with placental factors, uterine inertia and history of cesarean section.The placental factors were closely related to the history of induced abortion and cesarean section, and increased year by year with the increase of cesarean section rate.Reduce the number of births, do a good job of family planning and maternal health care, early prevention.Step up efforts to publicize the benefits of normal childbirth.In order to reduce the incidence of placenta previa placenta accreta and uterine rupture and then to reduce the incidence of hysterectomy.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R713.42

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