国际生殖健康/计划生育杂志 ›› 2025, Vol. 44 ›› Issue (4): 342-347.doi: 10.12280/gjszjk.20250093

• 综述 • 上一篇    下一篇

产后子宫坏死的高危因素及诊治进展

谢江燕, 杨丹()   

  1. 570100 海口,海南省妇女儿童医学中心产科(谢江燕); 成都中医药大学附属医院妇产科(杨丹)
  • 收稿日期:2025-03-01 出版日期:2025-07-15 发布日期:2025-07-28
  • 通讯作者: 杨丹,E-mail:hello80318@163.com

High-Risk Factors, and Diagnosis and Treatment of Postpartum Uterine Necrosis

XIE Jiang-yan, YANG Dan()   

  1. Department of Obstetrics, Hainan Women and Children′s Medical Center, Haikou 570100, China (XIE Jiang-yan); Department of Obstetrics and Gynecology, Hospital of Chengdu University of TCM, Chengdu 610072, China (YANG Dan)
  • Received:2025-03-01 Published:2025-07-15 Online:2025-07-28
  • Contact: YANG Dan, E-mail: hello80318@163.com

摘要:

产后子宫坏死临床罕见,仅在少数病例报告中有报道,该病与子宫缺血和细菌感染密切相关,预后差,常需行子宫切除术。子宫动脉栓塞术、子宫压迫缝合术和盆腔血管结扎术是治疗难治性产后出血的重要方法,主要通过阻断子宫血流达到止血的目的,但联用多种止血方法常会引起子宫缺血,如合并生殖道炎症可能会加重感染,导致子宫坏死,并具有潜在的死亡风险。产后子宫坏死目前尚无标准化的治疗方案,多学科团队联合管理能够早期识别、及时控制病情、避免严重并发症的发生,改善子宫血流、积极控制感染是预防子宫坏死的关键。从产后子宫坏死的高危因素、预防策略和临床诊治思路进行阐述,旨在提高产科医生的预警识别和处置能力,保护孕产妇生殖功能和生命安全。

关键词: 子宫, 坏死, 产后出血, 子宫动脉栓塞术, 缝合技术, 感染

Abstract:

Postpartum uterine necrosis is a rare condition, with only a few cases reported in the literature. It is closely associated with uterine ischemia and bacterial infections, with a poor prognosis, often necessitating hysterectomy. Uterine artery embolization, uterine compression suturing, and pelvic vessel ligation are important methods for managing refractory postpartum hemorrhage, primarily by interrupting uterine blood flow to achieve hemostasis. However, the combined use of multiple hemostatic techniques can often lead to uterine ischemia. If the patient also has concurrent genital tract inflammation, the infection may be exacerbated, leading to uterine necrosis and posing a potential risk of mortality. Currently, there is no standardized treatment protocol for postpartum uterine necrosis. Multidisciplinary team management can facilitate early identification and timely control of the condition, thereby preventing severe complications. Improving uterine blood flow and actively controlling infections are critical for preventing uterine necrosis. This article discusses the risk factors, preventive strategies, and clinical management approaches for postpartum uterine necrosis. The aim is to enhance obstetricians ' abilitity of identifying

risks and manage complications, thereby protecting maternal reproductive function and ensuring life safety.

Key words: Uterus, Necrosis, Postpartum hemorrhage, Uterine artery embolization, Suture techniques, Infections