Chen L H, Lai S F, Lee W H, Leong N K
Department of Reproductive Medicine, Kandang Kerbau Hospital, Singapore.
Singapore Med J. 1995 Feb;36(1):63-7.
The purpose of this study was to determine the incidence, presentation, management and outcome of uterine perforation during elective first trimester abortions.
We conducted a retrospective study of 40 patients, including 2 transferred patients, who sustained uterine perforation during elective abortions from January 1980 to December 1992.
The incidence of uterine perforation was 0.8 per 1,000 procedures (0.08%). There were 8 (20%) nulliparae and 3 (7.5%) grand multigravidae. 82.5% of the cases occurred when the abortion was performed by medical officers or junior registrars under training. The commonest perforating instrument was the suction cannula (25%) followed by the uterine sound (22.5%) and the dilator (20%). Three (7.5%) cases were treated conservatively, 33 (82.5%) cases underwent emergency operation, 2 (5%) cases were discovered during subsequent sterilisation, and 2 (5%) cases suffered undiagnosed perforation and were re-admitted for emergency surgery. Morbidity included post operative fever (12.5%), bowel injury (7.5%), retained conceptus (5%) and wound breakdown (2.5%). There was no mortality.
A careful assessment of the uterine size and position, vigilance in the use of uterine sound and dilators, greater care in the use of suction cannula, and experience in vacuum aspiration will decrease the incidence of uterine perforation during elective abortions. A high degree of suspicion, early diagnosis and treatment will prevent the potential complications that may arise from uterine perforation.
本研究旨在确定选择性孕早期人工流产术中子宫穿孔的发生率、表现、处理及结局。
我们对1980年1月至1992年12月期间在选择性人工流产术中发生子宫穿孔的40例患者进行了回顾性研究，其中包括2例转诊患者。
子宫穿孔的发生率为每1000例手术0.8例（0.08%）。有8例（20%）为未产妇，3例（7.5%）为多次妊娠的经产妇。82.5%的病例发生在由医务人员或接受培训的初级住院医师进行人工流产时。最常见的穿孔器械是吸管（25%），其次是子宫探针（22.5%）和扩张器（20%）。3例（7.5%）患者接受保守治疗，33例（82.5%）患者接受急诊手术，2例（5%）患者在随后的绝育手术中被发现，2例（5%）患者发生未被诊断的穿孔并再次入院接受急诊手术。并发症包括术后发热（12.5%）、肠道损伤（7.5%）、妊娠物残留（5%）和伤口裂开（2.5%）。无死亡病例。
仔细评估子宫大小和位置，使用子宫探针和扩张器时保持警惕，使用吸管时更加小心，以及具备真空吸引经验，将降低选择性人工流产术中子宫穿孔的发生率。高度怀疑、早期诊断和治疗将预防子宫穿孔可能引发的潜在并发症。
