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目的探讨产科急诊子宫切除术后再次腹腔探查术的原因及术中注意事项。方法采用回顾性研究方法对2009年1月至2015年12月运城市中心医院收治的10例产科急诊子宫切除术后再次腹腔探查术患者的临床资料进行分析。结果 7年间运城市中心医院因难治性产后出血子宫切除9例,外院因产后出血在当地行子宫切除43例。52例子宫切除患者中再次腹腔探查术10例,发生率19.2%。10例患者均因外院产科急诊行子宫切除后伴失血性休克转入运城市中心医院,其中2例膀胱损伤,2例中有1例合并输尿管损伤。10例剖腹探查手术盆腹腔积血中位数为4450 m L(2100~6300 m L),总出血量中位数为13 700 m L(9600~20 900 m L),入院时血红蛋白中位数45 g/L(38~61 g/L),输注红细胞中位数为44.5 U(32~66 U)。术后急性肾功能衰竭5例,多器官功能障碍综合征(MODS)3例,术后感染3例,盆腔血肿7例,住院治疗9例痊愈,1例死亡。结论产科急诊子宫切除术后再次腹腔探查术的主要原因是首次手术止血不彻底,术后瘪陷的末梢循环恢复血管扩张,凝血功能障碍未能有效控制。
Objective To investigate the causes of intra-abdominal exploration after obstetric emergency hysterectomy and its precautions. Methods A retrospective study was conducted to analyze the clinical data of 10 patients who underwent emergency celiac resection after obstetric emergency hysterectomy in Yuncheng Central Hospital from January 2009 to December 2015. Results In 7 years, Yuncheng Central Hospital for refractory postpartum hemorrhage hysterectomy in 9 cases, outside the hospital due to postpartum hemorrhage in the local hysterectomy 43 cases. Among the 52 cases with hysterectomy, 10 cases underwent another celiac exploration, the incidence rate was 19.2%. All 10 patients were transferred to Yuncheng Central Hospital for hemorrhagic shock after hysterectomy due to obstetric emergencies in the outpatient department, including 2 cases of bladder injury and 1 of 2 cases with ureteral injury. The median abdominal hemorrhage volume in operation laparotomy was 4450 m L (2100 ~ 6300 m L) and the median total blood loss was 13 700 m L (9600 m 20 900 m L). The median hemoglobin concentration 45 g / L (38 ~ 61 g / L), and the median number of red blood cells transfused was 44.5 U (32 ~ 66 U). Postoperative acute renal failure in 5 cases, multiple organ dysfunction syndrome (MODS) in 3 cases, postoperative infection in 3 cases, pelvic hematoma in 7 cases, hospitalized 9 cases recovered, 1 case died. Conclusions The main reason of reoperation after obstetric emergency hysterectomy is that the first operation is not complete, and the peripheral circulation of collapsed deflated vessels resumes vasodilatation and coagulation dysfunction can not be controlled effectively.