【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。更多还原

【Abstract】 Objective: To explore the diagnosis,therapy and prognosis of utero-subserosa vein spalling during gestational period.Methods: Clinical data of 4 pregnant cases with utero-subserosa 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 antero-liver hydrops were found.Non-clotting 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: Utero-subserosa 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.更多还原