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目的:探讨非脱垂大子宫阴式切除术(TVH)术后腹腔内大出血的原因、处理及预防措施。方法:回顾性分析我院自1995年8月-2010年10月行非脱垂大子宫TVH 960例患者中6例术后早期腹腔内大出血并成功止血患者的临床资料。结果:腹腔内大出血共6例,发生率0.62%,其中子宫肌瘤4例,子宫肌腺症2例。子宫平均如孕10周大小,平均重322 g。6例中2例同时行双侧附件切除术。术中出血量50～200 ml,平均100ml。术后早期腹腔内大出血400～1 900 ml,平均1 095 ml。5例经阴道重新结扎止血成功,1例给予止血药、补液等保守治疗后止血成功。结论:非脱垂大子宫TVH术后腹腔内出血是严重的围手术期并发症之一,处理须及时。术中认清解剖、止血彻底是减少此类并发症发生的重要措施。
Objective: To investigate the causes, treatment and preventive measures of intraperitoneal hemorrhage after non-prolapsed hysterectomy (TVH). Methods: The clinical data of 6 patients with early postoperative intrahepatic hemorrhage and successful hemostasis were retrospectively analyzed in our hospital from August 1995 to October 2010 in 960 cases of non-prolapsed large uterine TVH. Results: Intraperitoneal hemorrhage in 6 cases, the incidence of 0.62%, of which 4 cases of uterine fibroids, 2 cases of adenomyosis. Uterine average size of 10 weeks pregnant, with an average weight of 322 g. In 6 cases, 2 cases underwent bilateral accessory resection at the same time. Intraoperative bleeding 50 ~ 200 ml, an average of 100ml. Early postoperative intraperitoneal hemorrhage 400 ~ 1 900 ml, an average of 1 095 ml. 5 cases of vaginal re-ligation to stop bleeding success, 1 case given hemostatic drugs, fluid and other conservative treatment of hemostatic success. Conclusion: Non-prolapsed large uterine TVH postoperative intraperitoneal hemorrhage is one of the serious perioperative complications, treatment should be timely. Clear understanding of anatomy surgery, hemostasis is an important measure to reduce the occurrence of such complications.