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目的:探讨产后出血行子宫急诊切除手术临床时机选择及预后效果。方法:本院于2008年1月至2012年12月共收治6例经保守治疗无效需行子宫切除手术的产妇,回顾性分析6例产妇的临床资料、手术方法、患者失血情况、术后并发症、母婴预后以及子宫切除的时机选择。结果:所有行子宫切除手术的患者中,手术指征主要是子宫乏力2例(33.3%)、前置胎盘1例(16.7%)、胎盘植入2例(33.3%)、羊水栓塞1例(16.7%)。其中6例患者中共有4例为经产妇,占66.7%,剖宫产4例,占66.7%,自然分娩2例,占33.3%,其中前置胎盘患者出血量最大,患者出血量为3225ml,而羊水栓塞患者中出血量较其他因素出血量少。6例患者均出现不同程度的并发症,母婴及胎儿预后效果理想。结论:产后出血行子宫切除手术主要的临床指征包括宫缩乏力、前置胎盘、胎盘植入、子宫破裂以及剖宫产,正确把握患者手术指征能有效提高患者手术成功率。
Objective: To investigate the clinical timing and prognosis of uterine emergency surgery in postpartum hemorrhage. Methods: The hospital from January 2008 to December 2012 were treated 6 cases of conservative treatment ineffective hysterectomy women, retrospective analysis of 6 cases of maternal clinical data, surgical methods, patients with blood loss, postoperative complications Disease, maternal and child prognosis and the timing of hysterectomy. Results: All patients underwent hysterectomy, the main indications for surgery were 2 cases of uterine atony (33.3%), placenta previa in 1 case (16.7%), placenta accreta in 2 cases (33.3%) and amniotic fluid embolism in 1 case 16.7%). Among 6 cases, 4 cases were maternal, accounting for 66.7%, 4 cases of cesarean section, accounting for 66.7%, 2 cases of spontaneous delivery, accounting for 33.3%, of which the largest amount of bleeding in patients with placenta previa, the patient’s bleeding was 3225ml, Amniotic fluid embolism in patients with bleeding less than other factors. All 6 patients showed different degrees of complications, and the prognosis of maternal and fetus was satisfactory. Conclusion: The main clinical indications of hysterectomy for postpartum hemorrhage include uterine atony, placenta previa, placenta accreta, uterine rupture and cesarean section. To correctly grasp the indications of patients can effectively improve the success rate of operation.