Bonfante Ramírez E, Bolaños Ancona R, Ambas Argüelles M, Juárez García L, Castelazo Morales E
Instituto Nacional de Perinatología, Méx., D.F.
Ginecol Obstet Mex. 1997 Jun;65:239-42.
On block hysterectomy is defined as the removal of the gravid uterus with its gestational content in situ. The described indications for the realization of this procedure are neoplastic process as the most frequent cause; septic process, persistent trophoblastic diseases, and hemorrhage due to anomalous placentation. This is a retrospective, descriptive study of twelve cases of on block hysterectomy collected from January 1989 to December 1994 at Instituto Nacional de Perinatología. An average age of 33.4 years was found. The number of pregnancies for this patients in average was found to be 4.1. The gestational age was established between 9 to 29 weeks. Four patients with a 4 or more previous miscarriage background. There were two reported cases having a multiple gestation. Among the complications found, there were three cases of hipovolemic shock and one with abcess of vaginal cupula. The average days of hospitalization was 5.3 days. We found no mortality at all in this study, and the histopathologic correlation accorded in 100% of the cases. In this five year review, 12 cases of on block hysterectomy were found, being the most frequent reason for it's realization the persistent trophoblastic diseases; severe hemorrhage in second place, and serious infection process in third. The observed complications were derived from the hemodynamic compromise of each patient. Even though on block hysterectomy is one rarely seen procedure, it most be in mind as an alternative therapeutical instance it most be carried out in third level institutions, with technology and human resources capable of solving any complication derived from this kind of surgery.
整块子宫切除术定义为原位切除妊娠子宫及其妊娠内容物。该手术的常见适应证为肿瘤性病变，这是最常见的原因；其次是感染性病变、持续性滋养细胞疾病以及异常胎盘植入导致的出血。这是一项回顾性描述性研究，收集了1989年1月至1994年12月在国家围产医学研究所进行的12例整块子宫切除术病例。患者平均年龄为33.4岁。这些患者平均妊娠次数为4.1次。孕周为9至29周。4例患者既往有4次或更多次流产史。报告了2例多胎妊娠病例。在发现的并发症中，有3例低血容量休克，1例阴道穹窿脓肿。平均住院天数为5.3天。本研究中未发现死亡病例，组织病理学相关性在所有病例中均为100%相符。在这五年的回顾中，发现了12例整块子宫切除术病例，实施该手术最常见的原因是持续性滋养细胞疾病；严重出血位居第二，严重感染过程位居第三。观察到的并发症源于每位患者的血流动力学损害。尽管整块子宫切除术是一种罕见的手术，但作为一种替代治疗方法，必须牢记在心，该手术应在具备解决此类手术衍生并发症技术和人力资源的三级医疗机构进行。
