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子宫切除术后阴道断端裂开

Author
Hye-Chun Hur, MD, MPH, FACOG
Section Editors
Tommaso Falcone, MD, FRCSC, FACOG
Howard T Sharp, MD
Deputy Editor
Kristen Eckler, MD, FACOG
Translators
梁硕, 住院医师

引言

阴道残端裂开是全子宫切除术(手术切除子宫及宫颈)的一种并发症，其虽然少见，但也有致病的可能。切除子宫标本后，阴道切口(阴道断端)或腹膜缺损需要予以缝合。阴道断端裂开是指阴道切口的裂开。阴道断端裂开也常被称作阴道断端分离或阴道断端破裂。这些术语都是指初始子宫切除术时曾缝合的阴道切口出现裂开。

阴道断端裂开后，腹腔或盆腔内容物可能会从阴道裂口处脱出。肠管脱出可导致严重的结果，包括腹膜炎、肠道损伤和坏死，以及脓毒症。此时需要及时实施手术和药物干预。

本文将总结全子宫切除术后阴道裂开的发病率、危险因素和治疗推荐。妇科手术的其他并发症将单独讨论。 (参见“妇科手术的并发症”)

发病率

子宫切除术后阴道断端裂开是一种罕见并发症，发病率约为0.24%-0.31%[1-4]。一项美国研究中，于同一家医疗机构接受全子宫切除术的11,606例患者中有28例(0.24%)发生了阴道断端裂开[3]。另一项大型多中心欧洲研究纳入了12,398例接受子宫切除术的患者，其中38例(0.31%)在术后出现了阴道断端裂开[4]。两项研究都纳入了因良性和恶性指征而行子宫切除术的患者。虽然一项研究报道阴道断端裂开的发生率接近1%，但样本量小得多(n=2382)，所以其研究结果不太可靠[5]。各类盆腔手术后阴道断端裂开的发病率为0.03%，具体发病率因手术方法不同而有所差异[6]。

腹腔镜子宫切除术后阴道断端裂开的发病率(0.64%-0.75%)高于经腹(0.15%-0.26%)和经阴道(0.08%-0.25%)路径[1-4,7-9]。据报道，在腹腔镜子宫切除术中，经阴道闭合后患者阴道断端裂开的发病率(0.18%-0.30%)低于经腹腔镜闭合后的裂开发病率(0.64%)[9]。尽管人们担心腹腔镜子宫切除术后阴道断端裂开的发病率会显著较高(4.93%)[1]，但一项随访研究表明其发病率较低，仅为0.75%[3]。

             

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Literature review current through: 2017-06 . | This topic last updated: 2015-08-05.
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