10年剖宫产变化及手术安全性的临床分析

Clinical analysis of cesarean section: ten-year progress and operational safety

目的探讨近10年间剖宫产率和指征的变化及手术的安全性。方法对1996年1月至2005年12月4 216例住院产妇临床资料进行回顾性分析。结果剖宫产率明显增高,剖宫产指征发生明显变化,而阴道助产率逐渐下降。剖宫产儿窒息率及死亡率明显低于阴道助产儿(P<0.01)。以色列Stark式剖宫产与腹壁纵切口子宫下段剖宫产并发症发生率有明显差异(P<0.01)。结论剖宫产率升高与社会因素、巨大儿增多有明显关系,也与手术改进、提高母儿的安全性有关。剖宫产的风险及并发症不可忽视,提高剖宫产安全性的关键在于及时诊断和处理妊娠合并症及异常产、正确掌握剖宫产指征、提高手术技巧、减少并发症。

Objective To investigate the application and indication of cesarean section and the safety of the procedure in the past 10 years. Methods 4 216 cases of delivery in our hospital from 1996 to 2005 were studied retrospectively. Results It was found that the rate of cesarean section increased significantly and its indications were changed greatly, .while the rate of spontaneous labor decreased gradually. Compared with that in labor per vagina, the rates of asphyxia and newbom death in ce- sarean section had declined evidently （ P 〈 0.01）. Besides, significant difference in operative complication was noticed between Israel Stark＇s method and abdominal longitudinal incision （P 〈 0.01）. Conclusion The rising rate of adopting cesarean section may be attributed to social factors, and especially, large fetus. It is also related to the improvements of surgical techniques and safety for mother and child. Though cesarean section sounds good for abnormal delivery, its risk and complication should not be neglected and the key to secure the safety is timely diagnosis and treatment of pregnancy complications and abnormal labor, correct decision on cesarean section, as well as perfection of surgical technique and reduction of complications.