中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
22期
10315-10320
,共6页
子宫破裂%诊断%预后%高危因素%治疗
子宮破裂%診斷%預後%高危因素%治療
자궁파렬%진단%예후%고위인소%치료
Uterine rupture%Diagnosis%Prognosis%High risk factors%Treatment
子宫破裂是指在分娩或妊娠期子宫体或下段发生的破裂，是产科严重并发症，母婴围生期死亡率极高。子宫破裂分为瘢痕与非瘢痕子宫破裂，分娩过程中超过90%的子宫破裂发生于既往有剖宫产史的妇女。瘢痕子宫是子宫破裂最常见的高危因素，其中与前次手术瘢痕的位置、形式，缝合方法、术后愈合情况及术后妊娠间隔时间等因素密切相关。非瘢痕妊娠子宫破裂罕见，可能与梗阻性难产、子宫收缩药物使用不当、产科手术损伤及胎盘植入等高危因素有关。而妊娠晚期非瘢痕子宫自发性破裂非常罕见，原因尚不清楚。分娩过程中突然出现的胎心率异常应考虑是子宫破裂一个潜在的危险信号，而超声检查对于早期诊断至关重要。子宫破裂一经确诊，在10～30 min内实施手术是降低围生期永久性损伤以及胎儿死亡的主要治疗手段，但须综合考虑到子宫损伤的程度、患者生命体征是否平稳、将来的生育要求及医师的技术等因素选择不同术式。本文将子宫破裂的高危因素及诊疗现状进行综述。
子宮破裂是指在分娩或妊娠期子宮體或下段髮生的破裂，是產科嚴重併髮癥，母嬰圍生期死亡率極高。子宮破裂分為瘢痕與非瘢痕子宮破裂，分娩過程中超過90%的子宮破裂髮生于既往有剖宮產史的婦女。瘢痕子宮是子宮破裂最常見的高危因素，其中與前次手術瘢痕的位置、形式，縫閤方法、術後愈閤情況及術後妊娠間隔時間等因素密切相關。非瘢痕妊娠子宮破裂罕見，可能與梗阻性難產、子宮收縮藥物使用不噹、產科手術損傷及胎盤植入等高危因素有關。而妊娠晚期非瘢痕子宮自髮性破裂非常罕見，原因尚不清楚。分娩過程中突然齣現的胎心率異常應攷慮是子宮破裂一箇潛在的危險信號，而超聲檢查對于早期診斷至關重要。子宮破裂一經確診，在10～30 min內實施手術是降低圍生期永久性損傷以及胎兒死亡的主要治療手段，但鬚綜閤攷慮到子宮損傷的程度、患者生命體徵是否平穩、將來的生育要求及醫師的技術等因素選擇不同術式。本文將子宮破裂的高危因素及診療現狀進行綜述。
자궁파렬시지재분면혹임신기자궁체혹하단발생적파렬，시산과엄중병발증，모영위생기사망솔겁고。자궁파렬분위반흔여비반흔자궁파렬，분면과정중초과90%적자궁파렬발생우기왕유부궁산사적부녀。반흔자궁시자궁파렬최상견적고위인소，기중여전차수술반흔적위치、형식，봉합방법、술후유합정황급술후임신간격시간등인소밀절상관。비반흔임신자궁파렬한견，가능여경조성난산、자궁수축약물사용불당、산과수술손상급태반식입등고위인소유관。이임신만기비반흔자궁자발성파렬비상한견，원인상불청초。분면과정중돌연출현적태심솔이상응고필시자궁파렬일개잠재적위험신호，이초성검사대우조기진단지관중요。자궁파렬일경학진，재10～30 min내실시수술시강저위생기영구성손상이급태인사망적주요치료수단，단수종합고필도자궁손상적정도、환자생명체정시부평은、장래적생육요구급의사적기술등인소선택불동술식。본문장자궁파렬적고위인소급진료현상진행종술。
Uterine rupture refers to the rupture of uterus or lower uterine segment during delivery or trimester of pregnancy, which is a serious complication of obstetrics and it causes a high mortality rate of mothers and children in the perinatal period. Uterine rupture can be classified into scared and non-scared rupture, and 90%of the uterine rupture during delivery occur in women with a history of cesarean section. Scared uterus is the most common risk factor of uterus rupture, which is closely related to the factors such as the previous location and form of the surgical scar, suture method, postoperative healing situation and pregnancy interval. The non-scared pregnancy uterine rupture is rare, which may be related to the high risk factors of obstructive dystocia, incorrect use of uterine contraction drugs, obstetric operation damage and placenta implantation. However, the spontaneous non-scared uterine rupture in late trimester of pregnancy is very rare, and the reason is not yet clear. The sudden appearance of abnormal fetal heart rate in the process of childbirth should be considered as a potential danger signal of uterine rupture, and ultrasound examination is crucial for early diagnosis. After uterine rupture is confirmed, operation within 10 to 30 min is the main treatment method to reduce the permanent damage and fetal death in the perinatal period. However, the damage degree of uterus and whether the patient’s vital signs are stable, future requirement of fertility and the technology level of the doctor should be comprehensively considered to choose different operation methods. The high risk factors and current situation of diagnosis and treatment of uterine rupture were reviewed in this article.
