摘要目的 分析前置胎盘患者发生非计划重返手术的原因,探讨减少和防范前置胎盘患者非计划重返手术的临床对策. 方法 回顾性分析南京医科大学第一附属医院产科2010年1月至2015年1月收治的571例前置胎盘患者中,行非计划重返手术的10例患者(1.75％)的临床资料.结果 10例患者中,7例因剖宫产术后发生严重出血而行非计划重返手术(术式包括子宫动脉介入栓塞术或者子宫切除术).3例前置胎盘中期妊娠行利凡诺引产术,其中2例联合子宫动脉介入栓塞术,术后因继发严重感染行剖宫取胎术;1例引产时因发生大出血转入本院行剖宫取胎术,术后再次发生严重产后出血,行子宫切除术.10例中的8例发生严重产后出血,平均出血总量(4 212±1 651)ml,第一次手术返回病房后再次出血量(2 206±736)ml,8例患者平均输注红细胞(23.7±9.0)U,输注血浆[M(min～max)]为1 845(390～3 960) ml,输注血小板5例、冷沉淀8例、白蛋白6例,纤维蛋白原5例.2次手术间隔时间[M(min～max)]为2.0(0.5～19.0)h.二次手术后平均住院时间(10.6±2.5)d,平均使用抗生素(9.2±2.3)d.10例产妇均治愈出院,7例剖宫产儿预后良好.结论 前置胎盘患者发生非计划重返手术的主要原因是首次手术后的严重产后出血.加强手术后监测,早期诊断及迅速手术,是控制严重产后出血、挽救孕产妇生命的重要手段.

abstractsObjective To analyze reasons for unplanned return-to-theater obstetrical surgery in patients with placenta previa, and to propose a strategy for prevention.Methods Among 571 patients with placenta previa in the Department of Obstetrics, First Affiliated Hospital of Nanjing Medical University from January 2010 to January 2015, ten cases (1.75％) who had an unplanned return-to-theater obstetrical surgery were retrospectively analyzed.Results Seven out of the ten cases returned to the theater due to severe hemorrhage after cesarean section and hysterectomy or uterine artery embolization was performed.The rest three pregnancies were terminated at mid-term with amniotic injection of rivanol, two of which developed severe infection after the induction combined with uterine artery embolization followed by cesarean section,and the other one finally had an emergent hysterectomy due to severe postpartum hemorrhage after cesarean section because of intrapartum hemorrhage.Severe postpartum hemorrhage occurred in eight out of the ten cases, with a mean volume of (4 212± 1 651) ml.Blood loss between the original and return-to-theater surgery was (2 206± 736) ml.In these eight cases, the mean volume of erythrocyte suspension transfusion was (23.7±9.0) U, and [M(min-max)] 1 845(390 3 960) ml for plasma transfusion.Platelet transfusion was performed in five cases, cryoprecipitate transfusion in eight cases, serum albumin transfusion in six cases, and fibrinogen transfusion in five cases.The interval between original and return-to-theater surgery was 2.0(0.5-19.0) h.After the return-to theater surgery, the time of antibiotic use was (9.2±2.3) d, and the duration of hospital stays was (10.6±2.5) d.No patient required further re-operation, and all were discharged without long-term sequelae.All seven neonates had a good prognosis.Conclusions Severe postpartum hemorrhage in patients after initial operation because of placenta previa is the primary indication for unplanned return-totheater surgery.Closed postoperative monitoring, early recognition and expedite return-to-theater surgery are crucial to stop bleeding and save lifes.