本文選題：子宮切除 + 相關因素　； 參考：《吉林大學》2014年碩士論文

【摘要】：產科子宮切除術是治療產科難于控制的出血，挽救孕產婦生命的重要手段及措施。隨著近年來剖宮產率的不斷增加，妊娠并發(fā)癥及合并癥的增多，增加了產科子宮切除的幾率。隨著產后出血保守治療方法的不斷改進，，如何避免產科子宮切除仍需要進一步研究。 目的：探討導致產科子宮切除的相關因素。 方法：1、回顧性分析2004年1月至2013年12月吉林大學第二臨床醫(yī)院收治的82孕產婦行子宮切除的患者病歷資料。病歷資料包括：年齡、孕周、孕產史、孕期情況（有無并發(fā)癥及合并癥）、分娩方式、產后出血量、保守治療方法、母兒結局。分析其發(fā)病率、期待治療方法、術中出血情況及處理方法、對孕婦及胎兒的影響。 2、將數(shù)據(jù)采用SPSS17.0統(tǒng)計學軟件進行統(tǒng)計學處理，采用t檢驗和2檢驗進行分析。 結果：調查中82例子宮切除患者中，行全子宮切除術25例，次全子宮切除術57例。外院分娩后轉入我院行子宮切除術19例，我院分娩后行子宮切除術63例。其中25例因前置胎盤合并胎盤植入行子宮切除術，14例因宮縮乏力行子宮切除術，前置胎盤及子宮破裂因素切除子宮各8例，胎盤植入因素7例，胎盤早剝6例，子宮切口感染5例，妊娠合并血液病、妊娠合并子宮肌瘤、妊娠合并重癥肝病各3例。57例有人工流產史，36例既往有剖宮產手術史。82例患者中正常分娩6例，剖宮產術終止妊娠76例。本研究的82例患者無一人死亡。將82例分娩后行子宮切除的原因進行單因素分析，其中胎盤因素（前置胎盤、胎盤植入、胎盤早剝）、宮縮乏力、剖宮產史有統(tǒng)計學意義(P0.05)。 結論：孕產婦子宮切除術是治療產后不可控制大出血，挽救孕產婦生命的有效措施之一。孕產婦子宮切除與胎盤因素、宮縮乏力、剖宮產史有關。其中胎盤因素與多次人工流產史、剖宮產史密切相關，并隨剖宮產率增加而呈逐年上升趨勢。減少孕產次，做好計劃生育和孕產期保健工作，做到早期預防。加大宣傳正常分娩好處的相關力度。正確掌握剖宮產的手術指征，從而降低前置胎盤、胎盤植入及子宮破裂的發(fā)生率，進而降低孕產婦子宮切除的發(fā)生率。
[Abstract]:Obstetrical hysterectomy is an important measure to treat the bleeding which is difficult to control in obstetrics and to save the life of pregnant and parturient.With the increasing rate of cesarean section and the increase of complications and complications of pregnancy, the probability of obstetrical hysterectomy has been increased.With the continuous improvement of conservative treatment of postpartum hemorrhage, how to avoid obstetrical hysterectomy still needs further study.Objective: to explore the related factors of obstetrical hysterectomy.Methods from January 2004 to December 2013, the medical records of 82 pregnant women undergoing hysterectomy in the second Clinical Hospital of Jilin University were retrospectively analyzed.Medical records include age, gestational age, gestational history, pregnancy (complications and complications, delivery, postpartum bleeding, conservative treatment, and maternal and fetal outcomes).The incidence, expectant treatment, intraoperative bleeding and treatment were analyzed, and the effects on pregnant women and fetuses were analyzed.2. The data were processed by SPSS17.0 software and analyzed by t test and 2 test.Results: total hysterectomy and subtotal hysterectomy were performed in 25 cases and 57 cases respectively.19 cases underwent hysterectomy after delivery in our hospital and 63 cases underwent hysterectomy after delivery in our hospital.Among them, 14 cases underwent hysterectomy because of placenta previa and placenta accreta, 8 cases of placenta previa and uterine rupture, 7 cases of placenta accreta, 6 cases of placental abruption, 14 cases of hysterectomy, 8 cases of placenta previa and uterine rupture, 7 cases of placenta accreta, 6 cases of placental abruption.There were 5 cases of uterine incision infection, 6 cases of pregnancy complicated with hematologic diseases, 3 cases of pregnancy with hysteromyoma, 3 cases of severe liver diseases, 3 cases of induced abortion, 36 cases of history of cesarean section and 6 cases of normal delivery.76 cases of pregnancy terminated by cesarean section.None of the 82 patients in this study died.The causes of hysterectomy after delivery were analyzed by univariate analysis. Placental factors (placenta previa, placenta accreta, placental abruption, uterine inertia and history of cesarean section) were statistically significant.Conclusion: hysterectomy is one of the effective measures to treat uncontrollable postpartum hemorrhage and save maternal life.Hysterectomy was associated with placental factors, uterine inertia and history of cesarean section.The placental factors were closely related to the history of induced abortion and cesarean section, and increased year by year with the increase of cesarean section rate.Reduce the number of births, do a good job of family planning and maternal health care, early prevention.Step up efforts to publicize the benefits of normal childbirth.In order to reduce the incidence of placenta previa placenta accreta and uterine rupture and then to reduce the incidence of hysterectomy.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R713.42

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