背景:紧急产科子宫切除术(EOH)是一种挽救生命的手术,通常用于治疗某些产科并发症,作为最后的手段,防止孕产妇死亡。
目的:本研究旨在确定适应症,UsmanuDanfodito大学教学医院(UDUTH)的EOH手术并发症,索科托.
方法:这项回顾性研究涉及所有在UDUTH时患有EOH的患者,索科托,尼日利亚,2005年1月至2010年12月。这些患者的病例记录从病历库和有关年龄的信息检索,奇偶校验,预订状态,适应症,子宫切除术的类型,外科医生的干部,麻醉类型,并提取手术并发症。数据通过SPSS11.5版本进行处理,并使用χ(2)检验分析一些结果,置信区间设置为95%。
结果:在6年期间,在16249例分娩中进行了83例EOH,前者的比率为0.51%,即196次交付中有1次。然而,只有74例患者(82.9%)的病例记录可用于研究.EOH的比率随着产妇年龄的增长和产次的增加而增加。大部分病人(89.2%)未预约接受产前护理,这些患者的手术率(1.82%)显著高于预订受试者的0.07%(P<0.001)。该手术的主要指征是子宫破裂(93.2%),大多数患者(95.9%)进行了子宫次全切除术。贫血(66.2%),出血过多(35.5%),败血症(18.9%),伤口感染(16.2%)是主要并发症。与顾问进行的手术(16.2%)相比,高级注册师进行的手术中的过度出血(51.2%)明显更高;P=0.03。EOH手术的病死率为12.1%。然而,由顾问和高级注册服务商执行的程序中的病死率分别为6.5%和16.3%,分别。
结论:中心的EOH发生率相对较高,子宫破裂是大部分手术的原因。防止长时间的难产,因此子宫破裂,通过产前护理和分娩监督将降低EOH的发生率,而由最有经验的外科医生进行手术将最大程度地降低孕产妇的发病率和死亡率。
BACKGROUND: Emergency obstetric hysterectomy (EOH) is a life-saving procedure which is often performed to treat some obstetric complications, as a last resort, to prevent maternal mortality.
OBJECTIVE: This study was designed to determine the rate, indications, and complications of the EOH procedure at Usmanu Danfodito University Teaching Hospital (UDUTH), Sokoto.
METHODS: This retrospective study involved all the patients who had EOH at UDUTH, Sokoto, Nigeria, between January 2005 and December 2010. The case records of these patients were retrieved from the medical record library and information relating to age, parity, booking status, indications, type of hysterectomy, cadre of the surgeon, type of anesthesia, and complications of the procedure were extracted. The data were processed via SPSS version 11.5 and the χ(2) test was used to analyze some of the results with the confidence limit set at 95%.
RESULTS: During the 6-year period, 83 EOH were performed out of 16,249 deliveries giving the rate of the former as 0.51%, i.e. 1 in 196 deliveries. However, the case records of only 74 patients (82.9%) were available for the study. The rate of EOH increased with advancing maternal age and increasing parity. The majority of the patients (89.2%) were unbooked for antenatal care, and the rate of the procedure among these patients (1.82%) was significantly higher than 0.07% observed amongst booked subjects (P<0.001). The main indication for the procedure was ruptured uterus (93.2%) and the majority of the patients (95.9%) had subtotal hysterectomy. Anemia (66.2%), excessive hemorrhage (35.5%), septicemia (18.9%), and wound infection (16.2%) were the leading complications. Excessive hemorrhage was significantly higher in the procedure performed by the senior registrars (51.2%) compared to those undertaken by consultants (16.2%); P=0.03. The case fatality rate of the EOH procedure was 12.1%. However, the case fatality rates in the procedure performed by consultants and senior registrars were 6.5% and 16.3%, respectively.
CONCLUSIONS: The rate of EOH in the centre is relatively high and ruptured uterus is responsible for the majority of the procedure. Prevention of prolonged obstructed labor, and therefore uterine rupture, through antenatal care and supervision of labor will reduce the rate of EOH whereas performance of the procedure by the most experienced surgeon will minimize the maternal morbidity and mortality.