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目的:子宫切除术是抢救产后出血有效的措施之一,剖宫产术中大出血时,正确把握子宫切除术的适应证及时机,以抢救孕产妇生命,提高产后出血抢救的成功率。方法:总结我院2006年1月~2011年12月6年期间剖宫产同时行子宫切除术病例共21例,通过回顾性分析,总结出剖宫产同时行子宫切除术原因(适应证)及其手术时机、产妇的预后等。结果:6年间,剖宫产产后出血,术中同时行子宫切除21例,手术适应证:前置胎盘合并胎盘植入12例;胎盘早剥致子宫胎盘卒中、子宫收缩乏力4例;子宫不完全破裂2例,妊娠合并巨大子宫肌瘤、多发性子宫肌瘤2例,剖宫产产后子宫收缩乏力1例。结论:剖宫产术中大出血时,在保守治疗无效的危急情况下,果断进行子宫切除术能抢救产妇生命,从而降低孕产妇死亡率。但同时子宫切除也给育龄妇女的身心健康造成一定的影响。在临床工作中,应及早发现和积极处理产科异常情况,避免病情恶化造成不必要的子宫切除,才能从根本上提高产科质量。但在危急情况下,果断的子宫切除术是抢救产妇生命的最有效方法。
Objective: Hysterectomy is an effective measure to rescue postpartum hemorrhage, cesarean section bleeding, the correct indication of hysterectomy and timing, to rescue maternal life and improve the success rate of postpartum hemorrhage. Methods: A total of 21 cases of cesarean section undergoing hysterectomy in our hospital from January 2006 to December 2011 were retrospectively analyzed. The causes of hysterectomy (indications) And the timing of surgery, maternal prognosis. Results: In 6 years, cesarean section postpartum hemorrhage, intraoperative simultaneous hysterectomy in 21 cases, surgical indications: placenta previa placenta accreta in 12 cases; placental abruption cause uterine placental stroke, uterine atony in 4 cases; uterus is not Complete rupture in 2 cases, pregnancy with huge uterine fibroids, multiple myomectomy in 2 cases, postpartum cesarean section uterine atony in 1 case. Conclusions: In the case of bleeding after cesarean section, decisive hysterectomy can save the life of the woman and reduce the maternal mortality when the treatment is ineffective. But at the same time, hysterectomy also affects the physical and mental health of women of childbearing age. In clinical work, we should find and actively deal with abnormal obstetric conditions, to avoid deterioration of the condition resulting in unnecessary hysterectomy, in order to fundamentally improve the quality of obstetrics. However, in a critical situation, decisive hysterectomy is the most effective way to rescue a woman’s life.