Zhang Yulong, Yan Jianying, Han Qing, Yang Tingting, Cai Lihong, Fu Yuelin, Cai Xiaolu, Guo Meimei
Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Medicine (Baltimore). 2017 Nov;96(45):e8443. doi: 10.1097/MD.0000000000008443.
The aim of the study was to review the operative experiences of emergency hysterectomy for life-threatening postpartum hemorrhage (PPH) performed over a 12-year period at Fujian Provincial Maternity and Children's Hospital; to examine the incidence and risk factors for emergency obstetric hysterectomy; and to evaluate the curative effectiveness and safety of subtotal hysterectomy for life-threatening PPH.The records of all cases of emergency obstetric hysterectomy performed at Fujian Maternity and Children Health Hospital between January 2004 and June 2016 were analyzed. The incidence, risk factors, and outcomes of hysterectomy, the peripartum complications, and the coagulation function indices were evaluated.A total of 152,023 of women were delivered. The incidence of emergency postpartum hysterectomy was 0.63 per 1000 deliveries: 96 patients underwent hysterectomy for uncontrolled PPH, 19 (0.207‰) underwent hysterectomy following vaginal delivery, and 77 (1.28‰) underwent the procedure following cesarean delivery (P < .001). Common risk factors included postpartum prothrombin activity ≤ 50% (61.5%), placenta accreta (43.76%), uterine atony (37.5%), uterine rupture (17.5%), and grand multiparity > 6 (32.3%). Forty-one patients underwent subtotal abdominal hysterectomy (STH) and 55 patients underwent total abdominal hysterectomy (TH). The mean operation time was significantly shorter for TH (193.59 ± 83.41 minutes) than for STH (142.86 ± 78.32 minutes; P = .002). The mean blood loss was significantly greater for TH (6832 ± 787 mL) than for STH (6329 ± 893 mL; P = .003). The mean number of red cell units transfusion was higher during TH (16.24 ± 9.48 units vs 12.43 ± 7.2, respectively; P = .047). Postoperative prothrombin activity was significantly higher than preoperative levels (56.84 ± 14.74 vs 44.39 ± 15.69, respectively; P < .001) in women who underwent TH and in those who underwent STH (57.63 ± 15.68 vs 47.87 ± 12.86, respectively; P < .001). There was no significant difference in the maternal complications after TH or STH for PPH.Cesarean deliveries were associated with an increased risk of emergency hysterectomy, and postpartum prothrombin activity < 50% was the greatest risk factor for hysterectomy in most women who underwent hysterectomy. STH was the preferred procedure for emergency obstetric hysterectomy.
本研究旨在回顾福建省妇幼保健院12年间因危及生命的产后出血（PPH）行急诊子宫切除术的手术经验；探讨急诊产科子宫切除术的发生率及危险因素；评估次全子宫切除术治疗危及生命的PPH的疗效及安全性。分析了2004年1月至2016年6月在福建省妇幼保健院行急诊产科子宫切除术的所有病例记录。评估了子宫切除术的发生率、危险因素及结局、围产期并发症和凝血功能指标。
共有152023名妇女分娩。急诊产后子宫切除术的发生率为每1000例分娩0.63例：96例患者因PPH控制不佳行子宫切除术，19例（0.207‰）经阴道分娩后行子宫切除术，77例（1.28‰）剖宫产术后行该手术（P<0.001）。常见危险因素包括产后凝血酶原活性≤50%（61.5%）、胎盘植入（43.76%）、子宫收缩乏力（37.5%）、子宫破裂（17.5%）和多产>6次（32.3%）。41例患者行腹式次全子宫切除术（STH），55例患者行腹式全子宫切除术（TH）。TH组的平均手术时间（193.59±83.41分钟）明显短于STH组（142.86±78.32分钟；P=0.002）。TH组的平均失血量（6832±787毫升）明显多于STH组（6329±893毫升；P=0.003）。TH组术中输注红细胞单位的平均数更高（分别为16.24±9.48单位和12.43±7.2单位；P=0.047）。行TH和STH的患者术后凝血酶原活性均明显高于术前水平（分别为56.84±14.74和44.39±15.69；P<0.001）（分别为57.63±15.68和47.87±12.86；P<0.001）。TH或STH治疗PPH后产妇并发症无明显差异。
剖宫产与急诊子宫切除术风险增加相关，产后凝血酶原活性<50%是大多数行子宫切除术妇女子宫切除的最大危险因素。STH是急诊产科子宫切除术的首选术式。
