【摘要】 目的：探讨妊娠期子宫浆膜下静脉自发破裂的诊断、治疗和预后。方法：回顾性分析本院6年内发生的4例妊娠期子宫浆膜下静脉自发破裂的临床情况。结果：妊娠期子宫浆膜下静脉自发破裂临床出现：4例均有急腹症表现，子宫张力高，3例未闻及胎心，1例胎心慢，行胎儿监护示自然减速。3例床边超声：死胎，未见胎盘早剥征像;肝前少量积液，腹腔积液。3例行腹腔穿刺抽出不凝血。4例急诊剖腹探查指征分别为：肝破裂，胎盘早剥，卵巢囊肿破裂，子宫破裂。腹腔出血平均为2 100 mL，输血量平均为1 200 mL。剖宫产加缝扎止血2例，次全子宫切除2例。死胎3例，活婴1例。产妇均痊愈出院。结论：妊娠期子宫浆膜下静脉自发破裂与子宫发育不良和胎盘植入相关，孕产妇和围产儿死亡率高,手术治疗是唯一手段。
【关键词】 妊娠，子宫;破裂，自发性;妇科外科手术
Clinical analysis of uterine vein spalling during gestational period
LI Yintao, SUN Li, WANG Xiaoyi, et al.
(Department of Gynaecology and Obstetrics, the Third Affiliated Hospital of Guangzhou Medical College, Guangzhou, Guangdong 510150，P.R.of China)
[ABSTRACT] Objective: To explore the diagnosis, therapy and prognosis of uterosubserosa vein spalling during gestational period. Methods: Clinical data of 4 pregnant cases with uterosubserosa vein spalling during gestational period in 6 years were analyzed, retrospectively. Results: All 4 cases had symptoms of acute abdomen, high tension of uterus, fetal heart not heard in 3 cases, one fetal heart rate slowed down naturally in fetal monitoring. Bedside ultrasound found fetal death in 3 cases and no sign of placental abruption. But seroperitoneum and anteroliver hydrops were found. Nonclotting blood was extracted by abdominal paracentesis in 3 cases. Exploratory laparotomy were taken in 4 cases due to hepatorrhexis, placental abruption, ruptured ovarian cyst and rupture of uterus. Average abdominal bleeding was 2100 ml, average transfusion was 1200 ml. Cesarean section plus transfixed haemostasis was done in 2 cases, subtotal hysterectomy was employed in 2 cases. Three had fetal death, one had living infant. All puerpera recovered and discharged. Conclusion: Uterosubserosa vein spalling during gestational period is related to hypoplasia of uterus and embedding placenta, mortality rate of puerpera and perinatal are higher. Surgery operation is the only way to cure.
[KEY WORDS] Gestation, u
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