Wu Xiaoyi, Jiang Wei, Xu Huan, Ye Xuping, Xu Congjian
1 Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China.
2 Department of Obstetrics and Gynecology, Shanghai Medical School, Fudan University, Shanghai 200032, People's Republic of China.
J Int Med Res. 2018 Sep;46(9):3630-3639. doi: 10.1177/0300060518776769. Epub 2018 Jun 19.
Objective An increasing trend of uterine rupture (UR) after laparoscopic surgery of the uterus (LSU) has been observed. Although the overall incidence is extremely low, UR may have catastrophic outcomes. Therefore, investigation of its potential risk factors is important. Methods We retrospectively reviewed the medical data of 10 women who developed UR after LSU performed at our hospital from October 2003 to October 2016 and conducted a literature review. Results All cases of UR occurred during the third trimester of pregnancy. The surgeries contributing to UR were laparoscopic myomectomy, adhesion decomposition, and salpingectomy, resulting in unfavorable outcomes especially for the fetus. Diathermy was routinely used for hemostasis, and multilayer suturing was not adequately performed in many cases. The posterior wall was the most common site of UR in most cases. Silent rupture with unremarkable symptoms was not rare. Similar risk factors were identified in the literature review. Conclusions Excessive use of energy equipment and the lack of multilayer suturing were the most common characteristics of UR after LSU. A history of LSU should always be considered a risk factor for UR.
目的 腹腔镜子宫手术（LSU）后子宫破裂（UR）的趋势呈上升态势。尽管总体发生率极低，但子宫破裂可能导致灾难性后果。因此，对其潜在危险因素进行调查很重要。方法 我们回顾性分析了2003年10月至2016年10月在我院接受LSU术后发生子宫破裂的10例患者的医疗数据，并进行了文献综述。结果 所有子宫破裂病例均发生在妊娠晚期。导致子宫破裂的手术包括腹腔镜子宫肌瘤切除术、粘连松解术和输卵管切除术，尤其对胎儿产生了不良后果。术中常规使用电凝止血，许多病例未充分进行多层缝合。大多数病例中，子宫后壁是子宫破裂最常见的部位。无症状的隐匿性破裂并不罕见。文献综述中也发现了类似的危险因素。结论 能量设备的过度使用和多层缝合的缺乏是LSU术后子宫破裂最常见的特征。LSU病史应始终被视为子宫破裂的危险因素。
