[围产期子宫切除术——2007年斯洛伐克的一项审计]

Mlyncek M, Kellner M, Uharcek P, Matejka M, Lajtman E, Boledovicová M

Gynekologicko-pôrodnicka klinika Fakultnej nemocnice, Nitra, Slovenská republika.

Ceska Gynekol. 2010 Apr;75(2):88-92.

OBJECTIVE

An audit was performed to assess the number, indications and complications of peripartum hysterectomy at the departments of obstetrics/gynecology in Slovakia in 2007.

DESIGN

Observational descriptive study.

SETTING

Department of Obstetrics and Gynecology, Faculty Hospital Nitra and Constantine the Philosopher University Nitra.

METHOD

An official questionnaire of Slovak Society of Obstetrics and Gynecology was sent to all 63 departments of obstetrics/gynecology to find the number of peripartum hysterectomy performed in the year 2007. Differences between intrapartum and postpartum cases were compared.

RESULTS

44 from 63 institutions responded to the survey (response rate 69.8%). There were 38,485 deliveries and 24 cases of peripartum hysterectomies. The incidence of peripartum hysterectomy was 0.62/1000 deliveries, 1 case occurred in 1604 deliveries. 16 (66.7%) patients had a total abdominal hysterectomy with the remaining 8 (33.3%) having a sub-total hysterectomy. All operations were emergent. 18 procedures were performed during delivery and 6 in the postpartum period. Hypogastric artery ligation before hysterectomy were performed on 2 patients in the postpartum group. 20 of 24 (83.3%) patients delivered by cesarean section, three (12.5%) by spontaneous vaginal delivery and one (4.2%) with vaccumextraction. The indications for emergency peripartum hysterectomy were: placenta praevia 6 cases (25%), placental abruption with disseminated intravascular coagulation 6 (25%), placenta accreta 3 (12.5%), uterine atony 3 (12.5%), uterine rupture 3 (12.5%) and retroperitoneal haematoma 3 (12.5%). The youngest patient was 15 year-old, the oldest one was 39. After hysterectomy 10 (41.7%) women were admitted to the intensive care unit. There was no maternal mortality, but five newborns died due to perinatal asphyxia. There were more blood transfusions in the group of postpartum hysterectomies in comparison with intrapartum cases (4.0 +/- 1.3 transfusion units vs 9.1 +/- 3.5, p < 0.05), as well as the longer hospital stay (10.3 +/- s4.2 days vs. 19.1 +/- 5.3, p < 0.05).

CONCLUSIONS

Peripartal hysterectomy is a dramatic but a life saving procedure. It is usually associated with significant maternal and fetal morbidity and mortality. Every obstetric service should have access to a surgical team capable of performing emergency peripartal hysterectomy.

目的

进行一项审计，以评估2007年斯洛伐克妇产科各科室围产期子宫切除术的数量、适应证及并发症。

设计

观察性描述性研究。

地点

尼特拉市大学医院妇产科及尼特拉市康斯坦丁哲学大学附属医院。

方法

向斯洛伐克妇产科协会的所有63个妇产科科室发送官方调查问卷，以了解2007年进行的围产期子宫切除术数量。比较产时和产后病例的差异。

结果

63家机构中有44家回复了调查（回复率69.8%）。共有38485例分娩，24例围产期子宫切除术。围产期子宫切除术的发生率为0.62/1000例分娩，即1604例分娩中有1例发生。16例（66.7%）患者接受了全腹子宫切除术，其余8例（33.3%）接受了次全子宫切除术。所有手术均为急诊。18例手术在分娩期间进行，6例在产后进行。产后组有2例患者在子宫切除术前进行了髂内动脉结扎。24例患者中有20例（83.3%）通过剖宫产分娩，3例（12.5%）自然阴道分娩，1例（4.2%）真空吸引分娩。急诊围产期子宫切除术的适应证为：前置胎盘6例（25%）、胎盘早剥伴弥散性血管内凝血6例（25%）、胎盘植入3例（12.5%）、子宫收缩乏力3例（12.5%）、子宫破裂3例（12.5%）及腹膜后血肿3例（12.5%）。最年轻的患者15岁，最年长的39岁。子宫切除术后，10例（41.7%）女性入住重症监护病房。无孕产妇死亡，但有5例新生儿因围产期窒息死亡。与产时病例相比，产后子宫切除术组输血更多（4.0±1.3个输血单位对9.1±3.5个，p<0.05），住院时间也更长（10.3±4.2天对19.1±5.3天，p<0.05）。