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妇科操作中的子宫穿孔

Author
Barbara S Levy, MD, FACOG
Section Editor
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Sandy J Falk, MD, FACOG
Translators
郝晓莹, 副主任医师

引言

子宫穿孔是所有宫腔操作的潜在并发症，可能引起周围血管或脏器(膀胱、肠管等)损伤[1,2]。此外，子宫穿孔及相关并发症可导致出血或脓毒症。若存在因素导致进入子宫内膜腔困难(如宫颈狭窄)或改变了子宫肌层壁强度(如妊娠、绝经)，则子宫穿孔的风险增加。

本文将总结妇科操作时子宫穿孔的预防、诊断及治疗。子宫手术的其他并发症将单独讨论。 (参见“妇科手术的并发症”和“宫腔镜概述”和“终止妊娠综述”)

发生率

子宫穿孔 — 子宫穿孔的发病率通常是根据外科医生的自我报告。而且，许多子宫穿孔的病例并没有被识别或者确诊，因此发病率很可能被低估了。

大多数研究表明，确诊的宫腔镜手术并发子宫穿孔的发生率约1%。在诊断性宫腔镜检查时较少出现子宫穿孔。 (参见“宫腔镜概述”，关于‘子宫穿孔’一节)

据报道，在因与妊娠无关的疾病而进行的刮宫术中，大约有0.3%的绝经前患者和2.6%的绝经后患者发生子宫穿孔。 (参见“扩宫和刮宫术”，关于‘子宫穿孔’一节)

                            

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Literature review current through: 2017-06 . | This topic last updated: 2017-07-07.
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