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中华产科急救电子杂志 ›› 2021, Vol. 10 ›› Issue (04) : 225 -229. doi: 10.3877/cma.j.issn.2095-3259.2021.04.008

论著

宫腔球囊填塞导致子宫破裂一例并文献复习
顾宁1, 郑明明1, 戴毅敏1,()   
  1. 1. 210008 南京大学医学院附属南京鼓楼医院妇产科
  • 收稿日期:2021-01-07 出版日期:2021-11-18
  • 通信作者: 戴毅敏

Uterine rupture complicating intrauterine balloon tamponade: a case report and review of cases

Ning Gu1, Mingming Zheng1, Yimin Dai1,()   

  1. 1. Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China
  • Received:2021-01-07 Published:2021-11-18
  • Corresponding author: Yimin Dai
引用本文:

顾宁, 郑明明, 戴毅敏. 宫腔球囊填塞导致子宫破裂一例并文献复习[J]. 中华产科急救电子杂志, 2021, 10(04): 225-229.

Ning Gu, Mingming Zheng, Yimin Dai. Uterine rupture complicating intrauterine balloon tamponade: a case report and review of cases[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2021, 10(04): 225-229.

目的

了解产后出血时宫腔球囊填塞导致子宫破裂的临床特点。

方法

回顾分析1例宫腔球囊填塞术导致子宫破裂的诊治经过,并以"产后出血"、"宫腔球囊"、"宫腔填塞"、"子宫破裂"、"Bakri球囊"、"宫缩乏力"、"子宫切除"等为关键词在Medline、万方数据库、维普、中国知网、生物医学文献数据库及Embase生物医学全文数据库2000至2020年收录的文献中进行检索,对本例及文献中宫腔球囊填塞导致子宫破裂患者的诊断及治疗方法进行分析。

结果

文献检索连同本例共有9例宫腔球囊填塞导致子宫破裂,其中7例使用Bakri球囊,1例使用BT-Cath球囊,1例使用宫腔球囊。球囊放置指征为阴道分娩后宫缩乏力(3例)、前置胎盘剖宫产后(2例)和晚期产后出血(4例);7例在宫腔压迫期间发生子宫破裂,2例发生在球囊放置时;5例原发性产后出血伴子宫破裂患者中,4例行子宫修补,1例行子宫切除;4例晚期产后出血伴子宫破裂均行子宫切除术。

结论

行宫腔球囊填塞术应警惕发生子宫破裂;应在超声监视下放置球囊;球囊填塞后仍然存在血流动力学不稳定时需考虑子宫破裂。

Objective

To analyze the clinical characteristics of uterine rupture caused by intrauterine balloon tamponade in postpartum hemorrhage.

Methods

The diagnosis and treatment of a case of uterine rupture caused by intrauterine balloon tamponade was reviewed. MEDLINE, Wanfang database, VIP, CNKI, Chinese Biomedical Database and Embase database from 2000 to 2020 were searched using keywords "postpartum hemorrhage" , "intrauterine balloon" , "uterine tamponade" , "uterine rupture" , "Bakri balloon" , "uterine atony" and "hysterectomy" . Diagnosis and treatment of uterine rupture complicating uterine balloon tamponade were abstracted and analyzed.

Results

In the literature, together with this case, 9 cases of intrauterine balloon tamponade complicated with uterine rupture were identified. 7 cases used Bakri balloon, 1 case used BT-Cath balloon and 1 case used intrauterine balloon. Indications for balloon placement included uterine atony after vaginal delivery in 3 cases, placenta previa after cesarean section in 2 cases, and late postpartum hemorrhage in 4 cases. Uterine rupture occurred during intrauterine balloon placement in 2 cases and during uterine tamponade in 7 cases. Among 5 cases of primary postpartum hemorrhage with uterine rupture, 4 cases underwent uterine repair and 1 case had hysterectomy; while in women with late postpartum hemorrhage and uterine rupture, hysterectomy was performed in all the 4 cases.

Conclusions

Doctors should be aware that uterine rupture is a severe complication of intrauterine balloon tamponade. Uterine balloon should be placed under ultrasound monitoring. If a patient had hemodynamic instability after uterine tamponade, uterine rupture should be suspected.

图1 宫腔球囊填塞导致患者子宫破裂腹部CT图。A:冠状面,子宫位于腹腔右侧,球囊位于左侧阔韧带内(箭头所示);B:横断面,球囊位于左侧阔韧带内(箭头所示),阔韧带内球囊周围积血,腹腔内积血
图2 宫腔球囊填塞导致患者子宫破裂图。术中见左侧阔韧带破口,球囊位于阔韧带内
表1 9例宫腔球囊填塞导致子宫破裂患者的临床特点
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