剖宫产术中子宫切口腹腔内、外缝合的随机对照研究

Uterine Repair with Exteriorisation or in Situ at Caesarean Section:A Randomized Controlled Trial

目的 比较剖宫产手术中子宫切口腹腔内与腹腔外缝合对产妇的影响。方法 采用随机对照试验方法 ,选择 2 2 0例单胎足月妊娠且无严重妊娠合并症和并发症的妇女 ,随机分配到两组 ,试验组 112例 ,对照组 10 8例。试验组在缝合子宫切口的过程中将子宫置于腹腔外 ,对照组则将子宫保留在腹腔内。观察手术前后血红蛋白含量的变化、围手术期血流动力学和动脉血氧饱和度的变化、术中术后出血量、手术时间、胃肠道反应以及术后胃肠功能恢复时间、术后发热和疼痛和其它手术并发症发生情况。数据分析采用SPSS 11 0软件。结果 两组术后血红蛋白含量均较术前下降 ,手术前后下降程度的比较显示腹腔内缝合组显著高于腹腔外缝合组(t=- 2 90 2 ,P =0 0 0 4 )。两组产妇间比较 ,围手术期的舒张压、脉搏和动脉血氧饱和度无显著性差异。两组产妇术前脉搏都较缝合子宫时及术后快 ,差异有统计学意义 (P <0 0 5 )。试验组收缩压在术前、缝合子宫时和术后三个时间点均低于对照组 (F =5 2 4 6 ,P =0 0 2 2 ) ,但组内 3个时间点比较没有统计学差异。手术时间、术中出血量、术中胃肠道症状和术后发热以及术后 3d疼痛评分上也无统计学差异。术后肛门开始排气时间腹腔内缝合组较试验组明显提前 (t=5 5 6 7,P =0 0 0 0 )。

Objective To compare the outcome of uterine exteriorisation repair with in situ in caesarean section. Methods A randomized controlled trial with 220 cases were recruited. Woman with term singleton pregnancy underwent caesarean section and without severe complication were randomly allocated to the two groups (112 cases in exteriorisation group and 108 cases in situ group). Women in treatment group received exteriorisation when the uterus was sutured, While others had the uterus repaired in situ as control. Main outcome measures included perioperative haemodynamic parameters, loss of blood, changes in haemoglobin concentration, duration of operation, postoperative pain score and febrile days, gastrointestinal discomforts and function recovery as well as postoperative maternal morbidity.Data were analyzed by SPSS 11.0.WT5'HZResults Haemoglobin concentration dropped in both groups after caesarean section, and the drops in control group was significantly higher than that of treatment group(Xt3=-2.902,XP3=0.004). In both groups, pulse before operation was markedly higher than when suturing the uterus and postoperation(XP3<0.05), but no difference was observed between the two groups. Systolic blood pressure of treatment group was lower than that of control group before operation, when suturing the uterus and after operation(XF3=5.246, XP3=0.022), but there was no difference among these 3 time points within the group. Onset of flatus was earlier in control group than in treatment group(XtWTB3=5.567,XP3=0.000).No difference was identified between the two groups when receiving the different suturing methods. No severe maternal morbidity was observed. Conclusions Uterine exteriorisation and in situ repair have similar ef fects on intra- and postoperative outcomes. In routine process of caesarean, section exteriorisation can be taken as an alternative method of suturing the uterus.