【作者】 史青杨；

【导师】 冯丽华；

【作者基本信息】 吉林大学 ， 临床医学， 2010， 硕士

【摘要】 孕产期(pregrancy and childbirth)是女性一生中一段特殊的生理时期,女性生殖期健康越来越引起社会的关注。近年来,因非意愿妊娠而致人工流产术、中期引产术逐渐增多,孕产期并发症也相应增多,妊娠中、晚期孕产妇子宫切除者也随之增多,子宫切除术对孕产妇身心造成严重伤害。妊娠中、晚期子宫切除高危因素产后出血所占比重较大,另外还有晚期产后出血。导致产后出血的原因有:子宫收缩乏力、胎盘因素、子宫破裂、软产道裂伤、凝血功能障碍等。不同年代引起中、晚期妊娠子宫切除高危因素的原因不尽相同。产后出血受相关因素影响,其病因构成比也不断变化。因此,治疗上应严格掌握手术指征,把握最佳治疗时机,选择适当治疗方式。本文收集了1999年3月至2010年3月间吉林大学第一医院收治的44例孕产期子宫切除患者病例资料。回顾性统计患者的年龄、孕周、孕次、产次、既往分娩史及产后出血病因,回顾性分析不同妊娠时期子宫切除构成比,不同年份孕产期子宫切除病因的变化,不同分娩方式子宫切除发生率,手术指征、手术时机及术式选择。结果表明:1、不同年份孕产妇子宫切除原因构成比不同,子宫切除中原因胎盘因素占比重最大。2、孕产期子宫切除发生率与孕产妇年龄似乎无相关性。各年龄段子宫切除病因构成比无显著性差异。3、剖宫产分娩并不能降低子宫切除发生率,使子宫切除发生率增高。4、临床医生应加强瘢痕子宫尤其是剖宫产术后宣教意识。更多还原

【Abstract】 Object:To investigate the clinical characters of the hysterectomy of pregrancy and childbirth.Methods:To retrospct maternal clinical data of patients of the First Hospital of Jilin University after hysterectomy from March ,1999 to March ,2010, analyse the general condition of the collection of cases, gestational age, gravida, parity, previous birth history, postnatal bleeding, hysterectomy during pregnancycons- titutes a different ratio, between March 1999 to March ,2010 , hysterectomy causes of maternal changes of mode of delivery rate of hysterectomy, surgical indications, surgical timing, surgical options were reviewed analysis.Results:1.The causes of hysterectomy of pregrancy and childbirth include placental factors (46.5%), uterine atony (23.3%), infection of the uterine incision or dehiscence after CS(18.6%), uterine rupture (7.0%), DIC (2.3%), amniotic fluid embolism (2.3%), etc, which accounts for largest proportion of placental factors. The constituent of of hysterectomy of pregrancy and childbirth in different pregrancy peoriod and years is different.⑴reasons of hysterectomy of gestational age between13 and 27 weeks: placental factors accounted for 50% of the total ,uterine rupture 50%;⑵reasons of hysterectomy causes of gestational age≥28 Weeks reasons: placental factors accounted for 46%,uterine atony for 27% , infection of the uterine incision or dehiscence after CS accounted for 21.6%, DIC accounted for 2.7%, amniotic fluid embolism accounted for 2.7% .⑶from February 1999 to March 2005,the reasons of hysterectomy of gestational age between13 and 27 weeks placental factors hysterectomy accounted for 66.7%, uterine rupture accounted for 33.3%; reasons of hysterectomy gestational age≥28 Weeks: uterine atony accounting for 57.1% of the first, uterine incision infection split for 28.6%,placental factors accounted for 14.3%, the largest proportion is uterine atony.⑷from March 2005 to March 2010,the reasons of hysterectomy of gestational age between13 and 27 weeks,uterine rupture accounted for 66.7%, placental factor accounted for33.3%; he reasons of hysterectomy of gestational age≥28 Weeks: Placental factors accounted for 53.4%, uterine atony accounts for 20 % infection of the uterine incision dehiscence 20%, placental factors accounted for the largest share. 2. pregnancy hysterectomy and maternal age, seems to be on relevance. Data, 29 to 30 years age group the highest rate of hysterectomy. 3, more productive pregnancy, history of cesarean section or induced abortion and maternal risk factors, a high proportion of pregnancy hysterectomy. 4.Clinical doctors should strengthen the scar uterine especially after cesarean section mission consciousness.Conclution:1.A leading cause of maternal hysterectomy factors, including the placenta, uterine atony, uterine dehiscence wound infection, uterine rupture, DIC, such as amniotic fluid embolism, placental factors which accounted for the largest share. sampling results indicated that hysterectomy causes, in different years than different, from March 1999 to March 2005, the proportion of uterine atony accounts for the largest, in March 2005 To March 2010, placental factors accounted for the largest share. 2 .pregnancy hysterectomy and maternal age, seems to be on relevance. 29 to 30 age group the highest rate of hysterectomy. cesarean delivery than vaginal delivery and hysterectomy hysterectomy. 3.more productive pregnancy, history of cesarean section or induced abortion and maternal risk factors, a high proportion of pregnancy hysterectomy.4.Clinical doctors should strengthen the scar uterine especially after cesarean section mission consciousness.更多还原