切换至 "中华医学电子期刊资源库"

中华产科急救电子杂志 ›› 2025, Vol. 14 ›› Issue (03) : 147 -151. doi: 10.3877/cma.j.issn.2095-3259.2025.03.005

降低产科出血改善不良妊娠结局

严重产后出血子宫切除的指征、时机及手术操作
杜培丽, 王志坚()   
  1. 510150 广州医科大学附属第三医院妇产科 广州重症孕产妇救治中心 广东省产科重大疾病重点实验室 广东省妇产科疾病临床医学研究中心 粤港澳母胎医学高校联合实验室
  • 收稿日期:2024-10-28 出版日期:2025-08-18
  • 通信作者: 王志坚

Indications, optimal timing, and key surgical techniques for hysterectomy in severe postpartum hemorrhage

Peili Du, Zhijian Wang()   

  • Received:2024-10-28 Published:2025-08-18
  • Corresponding author: Zhijian Wang
引用本文:

杜培丽, 王志坚. 严重产后出血子宫切除的指征、时机及手术操作[J/OL]. 中华产科急救电子杂志, 2025, 14(03): 147-151.

Peili Du, Zhijian Wang. Indications, optimal timing, and key surgical techniques for hysterectomy in severe postpartum hemorrhage[J/OL]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2025, 14(03): 147-151.

严重产后出血常导致失血性休克、弥散性血管内凝血、肾功能衰竭及席汉综合征等严重的产科不良结局,是造成产妇死亡的重要原因。当发生严重产后出血、所有非手术治疗措施均无效且产妇生命安全受到显著威胁时,子宫切除手术便成为挽救生命的重要手段。本文从严重产后出血时子宫切除术的适应证、手术时机及操作要点进行讨论。

Severe postpartum hemorrhage frequently leads to critical obstetric complications such as hemorrhagic shock, disseminated intravascular coagulation, renal failure, Sheehan syndrome, constituting a significant cause of maternal mortality.When severe postpartum hemorrhage occurs, all non-surgical treatment measures are ineffective, and the life safety of the mother is seriously threatened, hysterectomy becomes a life-saving intervention. This article discusses the indications, optimal timing and surgical procedures for hysterectomy in the context of severe postpartum hemorrhage.

[1]
Kozek-Langenecker SA, Ahmed AB, Afshari A, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: first update 2016[J]. Eur J Anaesthesiol201734(6):332-395.
[2]
中华医学会妇产科学分会产科学组,中华医学会围产医学分会. 产后出血预防与处理指南(2023)[J]. 中华妇产科杂志202358(6):401-409.
[3]
Ushida T, Kotani T, Imai K, et al. Shock index and postpartum hemorrhage in vaginal deliveries: a multicenter retrospective study[J]. Shock202155(3):332-337.
[4]
Muñoz M, Stensballe J, Ducloy-Bouthors AS, et al. Patient blood management in obstetrics: prevention and treatment of postpartum haemorrhage. A NATA consensus statement[J]. Blood Transfus201917(2):112-136.
[5]
Liu CN, Yu FB, Xu YZ, et al. Prevalence and risk factors of severe postpartum hemorrhage: a retrospective cohort study[J]. BMC Pregnancy Childbirth202121(1):332.
[6]
Rath W, Hackethal A, Bohlmann MK. Second-line treatment of postpartum haemorrhage (PPH)[J]. Arch Gynecol Obstet2012286(3):549-561.
[7]
Christopoulos P, Hassiakos D, Tsitoura A, et al. Obstetric hysterectomy: a review of cases over 16 years[J]. J Obstet Gynaecol201131(2):139-141.
[8]
何镭,刘兴会. 产科紧急子宫切除[J]. 实用妇产科杂志201834(07):489-491.
[9]
杨怡珂,陈欢,赵扬玉,等. 北京市区域严重产后出血分级诊疗及转诊管理的现况调查[J]. 实用妇产科杂志2024(3):186-191.
[10]
Zhang H, Dou R, Yang H, et al. Maternal and neonatal out-comes of placenta increta and percreta from a multicenter study in China[J]. J Matern Fetal Neonatal Med201932(16):2622-2627.
[11]
van den Akker T, Brobbel C, Dekkers OM, et al. Prevalence, indications, risk indicators, and outcomes of emergency peripartum hysterectomy worldwide: a systematic review and meta-analysis[J]. Obstet Gynecol2016128(6):1281-1294.
[12]
Yunas I, Islam MA, Sindhu KN, et al. Causes of and risk factors for postpartum haemorrhage: a systematic review and meta-analysis[J]. Lancet2025405(10488):1468-1480.
[13]
Mbakwa MR, Tendongfor N, Ngunyi YL, et al. Indications and outcomes of emergency obstetric hysterectomy: a 5-year review at the Bafoussam Regional Hospital, Cameroon[J]. BMC Pregnancy Childbirth202121(1):323.
[14]
Verma A, Sharma G, Kashyap M. A retrospective analysis of emergency obstetric hysterectomy: a life-saving intervention[J]. Cureus202315(10):e46758.
[15]
Rahman J, Al-Ali M, Qutub HO, et al. Emergency obstetric hysterectomy in a university hospital: a 25-year review[J]. J Obstet Gynaecol200828(1):69-72.
[1] 刘振清, 黄莉, 王帅, 谢晨欣, 刘鸿圣. 胎盘MRI评分联合临床特征对胎盘植入性疾病孕妇产后出血的预测价值[J/OL]. 中华妇幼临床医学杂志(电子版), 2025, 21(01): 37-43.
[2] 李霞林, 贺芳. 产后出血风险评估和早期预警系统[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 498-503.
[3] 张舒沁, 陈练. 产后宫腔内妊娠物残留的诊断和临床处理[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 493-497.
[4] 李小飞, 刘洪莉, 石丘玲, 田静, 李莉, 漆洪波, 罗欣. 自然分娩产妇低强度聚焦超声子宫复旧治疗防治产后出血的前瞻性随机对照研究[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 534-539.
[5] 吕名蕊, 刘世佳, 任冉, 韩璐. 大子宫切除术-单孔腹腔镜与vNOTES谁优谁劣[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 16-20.
[6] 严斌, 缪慧娴, 王酉, 狄文, 楼微华. 经阴道内镜与单孔腹腔镜在子宫切除术中的应用比较[J/OL]. 中华腔镜外科杂志(电子版), 2024, 17(01): 39-44.
[7] 杨晓英, 张葛, 徐晓萌, 孙雅欣, 苗月圆, 马迎春. 三种不同腹腔镜入路行大子宫切除术临床疗效评估[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(06): 331-337.
[8] 竺洁, 熊钰. 严重产后出血与凝血功能障碍[J/OL]. 中华产科急救电子杂志, 2025, 14(03): 133-138.
[9] 卫焱星, 黄莉萍. 缩宫素在防治产后出血临床应用中的过去、现在和未来[J/OL]. 中华产科急救电子杂志, 2025, 14(03): 139-143.
[10] 潘玮辰, 郑明明. 动脉栓塞术在严重产后出血中的应用[J/OL]. 中华产科急救电子杂志, 2025, 14(03): 144-146.
[11] 付以琳, 丁文成. 严重产后出血容量复苏[J/OL]. 中华产科急救电子杂志, 2025, 14(02): 75-79.
[12] 周玮. 严重产后出血的早识别[J/OL]. 中华产科急救电子杂志, 2025, 14(02): 70-74.
[13] 雷雨钦, 王晓怡. 通过模拟培训提高医护人员对严重产后出血的救治能力[J/OL]. 中华产科急救电子杂志, 2025, 14(02): 80-85.
[14] 叶湘云, 麻希洋, 贺芳. 产后大出血合并肺出血一例并文献复习[J/OL]. 中华产科急救电子杂志, 2025, 14(01): 46-53.
[15] 吕丽爱, 赖林强, 张登科. 罕见髂外动脉起源子宫动脉相关的产后出血一例[J/OL]. 中华介入放射学电子杂志, 2025, 13(02): 190-192.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?