剖宫产适应症、手术方法及并发症的探讨

A Clinical Analysis on 810 Cases with Cesarean Section

目的探讨剖宫产的适应症、手术方法及其并发症的处理和预防。方法回顾性分析我院2005年1月-2005年12月间所行剖宫产810例临床资料。结果剖宫产率为同期分娩总例数1329例(601),其中社会因素418例(52%);符合或基本符合手术指征者392例(48%),其中妊娠高血压62例(7%),胎儿宫内窘迫52例(6%),臀位46例(5%),妊娠期胆汁瘀积症(ICP)38例(4%),前置胎盘23例(2%);并发症包括产后出血19例;新生儿重度窒息16例;死亡4例;切口感染6例;液化延迟愈合16例。结论社会因素占剖宫产指征的首位,且呈不断上升趋势;而胎儿窘迫、胎位不正、妊娠期胆汁瘀积、前置胎盘、胎膜早破、瘢痕子宫等病理因素却降于次要位置,且指征有所放宽;椎管内硬膜外阻滞麻醉、经腹横切口子宫下段剖宫产术方法满意;正确选择适应症、麻醉及术式可有效减少和预防胎儿窒息和胎儿娩出困难;按摩子宫、注射宫缩剂、宫腔纱布填塞,结扎子宫动脉,必要时果断切除子宫可避免因失血过多贻误抢救时机。

Objective To study the operative indication, approaching, surgical procedures, complications and their prevention of cesarean section. Methods A group of clinical findings of 810 cases underwent cesarean section during Jan. 2005 to Dec. 2005 were analyzed retrospectively. Results The ratio of cesarean section accounted for the total number 1329 cases of delivery in the same term was 60%. The indications for the operation are social causation in 418 cases （52%）, medical reasons only in 392（48% ） including pregnant hypertension in 62 cases（7% ）, intrauterine fetus strait 52cases（6% ） , breech in 46 cases（5% ）, intrahepatic cholestasis in pregnancy （ICP） in 38cases（4% ） , placenta previa in 23 cases （2%） ;The complications were including bleeding in 19 cases, sever neonate asphyxia in 16 cases resulted in 4 cases death ,incision infection in Ⅰ case and incision delayed healing up due to liquefaction in 16 cases, Conclusion Social factors took up primacy of the cesarean section indications and tended to increase. On the contrary, the medical indications such as pregnant hypertension, neonate asphyxia, ICP etc were secondary reasons. Proper indication selection, peridural anesthesia and hypogastric transverse section are satisfactory to decrease and prevent neonate asphyxia and difficulties of taking-out. It could be effective to control postpartum hemorrhage by uterus massage, uterotonics injection, intrauterine packing. If necessary, uterine arteries ligation or uterectomy timely should be performed.