妇产科医院中因胎盘异常植入而接受剖宫产子宫切除术患者的泌尿系统损伤。

Urological lesions in patients undergoing obstetric hysterectomy secondary due to abnormal placental insertion in a high specialty hospital.

机构信息

División de Ginecología. Unidad Médica de Alta Especialidad, Hospital de Gineco Obstetricia No. 3 Dr. Víctor Manuel Espinosa de los Reyes Sánchez, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México.

Servicio de Urología Ginecológica. Unidad Médica de Alta Especialidad, Hospital de Gineco Obstetricia No. 3 Dr. Víctor Manuel Espinosa de los Reyes Sánchez, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México.

出版信息

Cir Cir. 2020;88(4):473-480. doi: 10.24875/CIRU.20000117.

DOI:10.24875/CIRU.20000117

PMID:32567587

Abstract

OBJECTIVE

To describe frequency and identify risk factors for urological lesions in patients undergoing obstetric hysterectomy secondary to abnormal placental insertion in a high specialty hospital.

MATERIAL AND METHODS

Transversal, retrospective study of patients underwent hysterectomy due to abnormal placental insertion, from 2017 to 2019; age, obstetric antecedents, comorbidities, type of abnormal placental insertion type of hysterectomy, site of urinary lesion, anesthesia, surgery time and bleeding were studied. Analyses were made with ji square and Kruskal Wallis tests with SPSS V20.0 program considering significative p values p < 0.05.

RESULTS

Clinical records of 96 patients with age 32.6 ± 6.1 years were analyzed. Accretism was present in 38.5%, incretism in 19.8% and percretism in 18.8%. Total hysterectomy was accomplished in 78 (81.2%) cases. Urinary lesion was present in 27 (28.1%); vesical in 19 (19.8%), ureteral in 6 (6.5%) and both in 2 (2.0%). Urinary lesion was significantly more frequent in those patients with more pregnancies (median 4 [interquartile range (IQR): 3-4] vs. 3 [2-4]; p= 0.004), more caesarean sections (4 [3-4] vs. 2 [1-3]; p < 0.001), hemorrhage (3000 mL [2000-4800] vs. 2000 mL [1200-3000]; p = 0.001), and more surgery time (3.75 h [3.5-4.0] vs. 3.0 [2.0-3.5]; p < 0.001).

CONCLUSIONS

Urinary lesions in patients undergoing obstetric hysterectomy secondary to abnormal placental insertion are more frequent with higher number of pregnancies, caesarean sections, hemorrhage and surgery time.

摘要

目的

描述在一家高专科医院中，因异常胎盘植入而接受产科子宫切除术的患者中泌尿系统损伤的频率，并确定其危险因素。

材料和方法

这是一项回顾性的横断面研究，纳入了 2017 年至 2019 年间因异常胎盘植入而接受子宫切除术的患者。研究的内容包括患者的年龄、产科病史、合并症、异常胎盘植入类型、子宫切除术类型、泌尿系统损伤部位、麻醉方式、手术时间和出血量等。采用卡方检验和 Kruskal-Wallis 检验进行数据分析，使用 SPSS V20.0 程序，p 值<0.05 认为差异有统计学意义。

结果

共分析了 96 例年龄为 32.6 ± 6.1 岁的患者的临床记录。其中胎盘粘连 38.5%，胎盘植入 19.8%，胎盘穿透 18.8%。78 例（81.2%）患者行全子宫切除术。27 例（28.1%）患者发生泌尿系统损伤，其中膀胱损伤 19 例（19.8%），输尿管损伤 6 例（6.5%），两者均损伤 2 例（2.0%）。泌尿系统损伤在有更多妊娠史（中位数 4 [四分位间距：3-4] 次 vs. 3 [2-4] 次；p=0.004）、更多剖宫产史（中位数 4 [3-4] 次 vs. 2 [1-3] 次；p<0.001）、更多出血量（3000 mL [2000-4800] vs. 2000 mL [1200-3000]；p=0.001）和更长手术时间（3.75 h [3.5-4.0] vs. 3.0 [2.0-3.5]；p<0.001）的患者中更为常见。