| Objective:Through summarizing the clinical data of 59 patients with uterine perforation,analyzing the causes,clinical manifestations,diagnosis and treatment of uterine perforation,improving the understanding of the disease,optimizing the diagnosis and treatment plan,finally achieve the goal to provide certain references for the clinical.Methods:A retrospective study was conducted to analyze the clinical data of 59 patients with uterine perforation who were admitted to the First Bethune Hospital of Jilin University from January 2013 to January 2021.The using database is established by Excel software.SPSS 25.0 statistical software was used for statistical analysis.Descriptive statistics(rate and mean)were used for clinical data,and chi-square test was used for counting data.P<0.05 showed statistical significance.Results:1.The age of 59 patients with uterine perforation ranged from 20 to 80 years,with an average age of 44.86±2.139 years old and a median age of 44 years old.Divided by an age group of 10 years old,12 cases(20.3%)were under 30 years old.14 cases(23.7%)aged from 30 to 39 years old;11 cases(18.6%)aged between 40 and 49 years old;7 cases aged 50 to 59 years old,accounting for 11.9%;9 cases aged 60-69 years,accounting for 15.3%;6 cases were ≥ 70 years old,accounting for 10.2%.According to the age classification standard of the World Health Organization in 2001,30 cases(50.8%)were in the young group of 18～44 years old.29 cases were aged≥45 years old,accounting for 49.2%.36 cases of premenopausal uterine perforation,accounting for 61.0%;Postmenopausal uterine perforation in 23 cases,accounting for 39.0%.The incidence of uterine perforation varies in different age groups.Uterine perforation mostly occurs in premenopausal women,especially in the 30-39 age group.For postmenopausal women,uterine perforation is more likely to occur in the 60-69 age group.2.Classification of uterine perforation:According to the presence or absence of exogenous factors,59 patients with uterine perforation were divided into two groups:spontaneous uterine perforation(35 cases,accounting for 59.3%)and secondary uterine perforation(24 cases,accounting for 40.7%).According to the degree of penetration of the uterine muscle wall,59 patients with uterine perforation were divided into three groups:partial uterine perforation(10 cases,accounting for 16.9%),which did not penetrate the serosal layer,complete uterine perforation which penetrated the serosal layer(42 cases,accounting for 71.2%)and unknown(7 cases,accounting for 11.9%).According to peripheral organ damage,59 patients with uterine perforation were divided into two groups:simple uterine perforation(37 cases,accounting for 62.7%)and complicated uterine perforation(22 cases,accounting for 37.3%).Combing the comparation of exogenous factors and eripheral organ damage,spontaneous uterine perforation often manifests as simple perforation,and secondary uterine perforation often manifests as complex perforation,and the difference is statistically significant(P<0.05).3.Causes of uterine perforation:Among 59 patients with uterine perforation,27 patients were associated with intrauterine device perforation,accounting for 45.8%;12 patients were associated with uterine inflammatory disease,accounting for 20.3%;patients were associated with scarred uterus 11 cases,accounting for 18.6%;6 cases of uterine perforation related to uterine cavity operation,accounting for 10.2%;2 cases of uterine perforation related to malignant tumors,accounting for 3.4%;1 case of pregnancy-related uterine perforation,accounting for 1.7%.4.Clinical manifestations of uterine perforation:52 cases(88.1%)of uterine perforation were symptomatic;7 cases(11.9%)were asymptomatic.Among 52 patients with symptoms,9 cases of simple abdominal pain,8 cases of abdominal pain associated with peritonitis symptoms,6 cases of abdominal pain accompanied by vaginal bleeding,5 cases of simple vaginal bleeding,3 cases of vaginal bleeding associated with secretion,3 cases of simple secretion was abnormal,2 cases of abdominal pain accompanied by secretion was abnormal,2 cases of abdominal pain,nausea and vomiting symptoms in peritonitis,There were 14 cases with other symptoms,including 1 case each.The main clinical manifestations of patients with uterine perforation are abdominal pain,vaginal bleeding,abnormal secretions,and symptoms of peritonitis.5.Methods of diagnosing uterine perforation:All 59 cases of uterine perforation were diagnosed through relevant examinations,and 31 cases(52.5%)were confirmed by one examination method.Among them,15 cases were confirmed by gynecological color ultrasound,15 cases were confirmed by full abdominal CT examination,and 1 case was confirmed by hysteroscopy.The remaining 28 cases(47.5%)were confirmed by the combination of gynecological color ultrasound examination and other examination means;Among them,22 patients received gynecological color ultrasound&full-abdominal CT examination,2 patients received gynecological color ultrasound&full-abdominal CT&pelvic MRI examination,2 patients received gynecological color ultrasound&full-abdominal CT&cystoscopy examination,1 patient received gynecological color ultrasound&abdominal plain film examination,and 1 patient received gynecological color ultrasound&abdominal plain film&full-abdominal CT examination.It can be seen that gynecological color Doppler ultrasound examination is the main method for diagnosing uterine perforation,and CT examination can further confirm whether there is uterine perforation.6.Uterine position:Among 59 cases of uterine perforation,52 cases have clearly recorded the location of uterine perforation,and 7 cases are unknown.Among the 52 patients with a clear record of the perforation site,23 were perforated in the anterior wall of the uterus,9 in the posterior wall,5 in the fundus,4 in both anterior and posterior walls,3 in the lateral wall,3 in the cervix,1 case had perforation,1 case of posterior wall&bottom of uterus,1 case of posterior wall of uterus&cervix,1 case of posterior wall of uterus&corner of uterus,1 case of fundus&corner of uterus.Among them,there were 22 cases with adjacent organ damage;including:15 cases with bowel damage,5 cases with parauterine tissue(including ovaries,uterine ligaments,fallopian tubes)damage,and 2 cases with bladder damage.There were 10 cases of partial uterine perforation(those who did not penetrate the serosal layer);42 cases of complete uterine perforation(those who penetrated the serosal layer);7 cases with unknown degree of penetration of the uterine muscle wall.Among 42 patients with complete uterine perforation(those who penetrated the serosal layer),30 had the size of the perforation site less than 1cm,and 12 had the size of the perforation site greater than 1cm,with the largest diameter reaching 7cm.It can be seen that uterine perforation is more common in perforation of the anterior wall of the uterus,often complete perforation,and most of the perforation sites do not exceed 1cm.7.Treatment method:Among the 59 patients with uterine perforation,32(54.2%)were treated with emergency surgery,and 27(45.8%)were treated with non-emergency surgery.Among them,57 patients(96.6%)underwent surgical treatment in our hospital;2 patients(3.4%)were transferred to our hospital for further treatment after surgery from a foreign hospital.Among the 57 surgical patients in our hospital,22 patients underwent transabdominal uterine suture repair,12 patients underwent transabdominal hysterectomy,7 patients had no bleeding at the site of uterine perforation without special treatment,and 7 patients underwent laparoscopic uterine suture.For repair surgery,4 patients were converted to laparotomy for total hysterectomy,2 patients underwent laparoscopic electrocoagulation,2 patients underwent hysteroscopic hot bulb electrocoagulation,and 1 patient only underwent transabdominal exploration.It can be seen that most patients with uterine perforation are treated by open surgery.8.Misdiagnosis:2 out of 59 uterine perforation patients were misdiagnosed,accounting for 11.1%;they were 62-year-old cervical cancer patients and 73-year-old endometritis patients,both were postmenopausal elderly patients.9.Hospitalization time:The hospital stay of 59 patients with uterine perforation ranged from 3 to 23 days,with an average hospital stay of 10.15±0.621 days.Among them,9 cases(15.3%)were hospitalized for less than 7 days;40 cases(67.8%)were hospitalized for 7-13 days;10 cases(16.9%)were hospitalized for more than 14 days.The shortest hospital stay of patients in the emergency surgery group was 3 days,the longest hospital stay was 23 days,and the average hospital stay was 10.34±0.948 days;the patients in the non-emergency surgery group had the shortest hospital stay of 3 days,the longest hospital stay was 22 days,and the average hospital stay was 9.93±0.779 days.It can be seen that there is no difference in hospitalization time between emergency surgery and non-emergency surgery.Conclusion:1.Uterine perforation mostly occurs in premenopausal women,especially in the 30-39 age group.If uterine perforation occurs in postmenopausal women,it’s more likely found in the 60-69 age group.Women with peritonitis symptoms after menopause are more likely to be misdiagnosed.2.The cause of uterine perforation in women varies among their ages.Uterine perforation of Premenopausal women,which often manifests as complex perforation,is mostly related to exogenous factors such as intrauterine contraceptive devices and uterine cavity operations.Uterine perforation of postmenopausal women,which often manifests as simple perforation,is related to the uterus empyema and malignant tumors of the uterus.3.As fast,non-invasive,reproducible,and low in price it is,Gynecological color Doppler ultrasound examination is the main examination for uterine perforation.The whole abdominal CT examination can further confirm uterine perforation.4.Uterine perforation of different causes occurs in different locations.Uterine perforation related to the IUD,which always accompanied by damage to the surrounding intestine,is common found in the anterior wall of the uterus,and;uterine perforation related to other uterine cavity operations is often found in the bottom of the uterus;uterine perforation associated with uterine inflammatory diseases is often found in the posterior wall of the uterus.5.Uterine perforation usually requires surgery,and postoperative anti-infection is very important for its recovery. |
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