Balachandran Aswini, Curtiss Natasha, Duckett Jonathan
Department of Obstetrics and Gynaecology, Medway Maritime Hospital, Windmill Road, Gillingham, Kent, UK, ME7 5NY.
Int Urogynecol J. 2015 Oct;26(10):1449-52. doi: 10.1007/s00192-014-2592-6. Epub 2014 Dec 16.
The retropubic mid-urethral sling (MUS) is the most commonly performed procedure for the treatment of stress urinary incontinence and is associated with a low risk of complications. Large retropubic haematomas occur sporadically and may have life-threatening consequences. Because of their infrequent nature, there is a dearth of information regarding this serious complication. The aim of this study was to identify the incidence of large haematomas and any lessons learnt from their treatment.
A retrospective cohort study was conducted between December 1999 and June 2014. Massive haematoma was defined as a haematoma greater than 8 cm and/or a drop in haemoglobin of more than 4 g/dl. The hospital notes of all patients diagnosed with a massive haematoma were reviewed and a detailed history, operation details and the information on the management of haematoma were obtained.
Seven (0.33 %) patients were identified with a massive retropubic haematoma out of a total of 2,091 retropubic MUS procedures performed. Six patients presented acutely with symptoms within 24 h. Haemoglobin levels dropped on average by 5.7 g/dl (range 2.9 to 8.6). The size of the haematoma ranged from 8 to 12 cm in diameter. Six patients required surgical drainage of the haematoma. Three patients received evacuation within 2 post-operative days. Haematomas were removed via laparotomy, vaginal drainage or suprapubic drainage.
Massive retropubic haematomas are uncommon but serious complications of MUS procedures. Our experience suggests that to reduce short- and long-term complications, early evacuation of massive haematomas via the suprapubic approach is recommended.
耻骨后尿道中段吊带术（MUS）是治疗压力性尿失禁最常用的手术方法，且并发症风险较低。巨大的耻骨后血肿偶有发生，可能会带来危及生命的后果。由于其发生率低，关于这一严重并发症的信息匮乏。本研究的目的是确定巨大血肿的发生率以及从其治疗中吸取的经验教训。
对1999年12月至2014年6月期间进行了回顾性队列研究。巨大血肿定义为血肿大于8厘米和/或血红蛋白下降超过4克/分升。对所有诊断为巨大血肿的患者的医院病历进行了回顾，并获取了详细的病史、手术细节以及血肿处理的信息。
在总共2091例耻骨后MUS手术中，有7例（0.33%）患者被确定为发生了巨大的耻骨后血肿。6例患者在24小时内急性出现症状。血红蛋白水平平均下降了5.7克/分升（范围为2.9至8.6）。血肿大小直径在8至12厘米之间。6例患者需要对血肿进行手术引流。3例患者在术后2天内接受了血肿清除。血肿通过剖腹手术、阴道引流或耻骨上引流清除。
巨大的耻骨后血肿是MUS手术中罕见但严重的并发症。我们的经验表明，为减少短期和长期并发症，建议通过耻骨上途径早期清除巨大血肿。
