规范化开展Stark剖宫产术的重要意义——附664例手术分析

Importance of standardization of Stark cesarean section--664 cases analysis

目的通过分析Stark剖宫产术的开展过程，探讨该术式的操作要点及效果，认识标准术式的优点，以促进该术式的规范化。方法依据时间顺序，按操作方法的差别，将择期Stark剖宫产术资料完整的病例分为两组，实施标准术式前的改良术式病例362例（A组），实施标准术式后的病例302例（B组）。比较两组手术时间、开腹至胎儿娩出时间、术中出血量、术后排气时间、术后病率、留置尿管时间、尿路刺激症状、切口感染、二次开腹手术时盆腹腔粘连情况。结果（1）平均手术时间：B组短于A组[（27．7±10．8）min和（35．6±15．2）min，P〈0．05]；开腹至胎儿娩出时间：B组短于A组[（4．92±1．21）min和（7．81±2．79）min，P〈0．053。（2）平均术中出血量：A组（214．3±62．1）ml和B组（201．5±53．1）ml比较无统计学意义（P〉0．05）。（3）平均术后排气时间：B组短于A组[（16．8±11．8）h和（25．9±12．7）h，P〈0．05）]。（4）术后病率：B组低于A组[1．3％（4／302）和4．7％（17／362），P〈0．053。（5）平均留置尿管时间：B组短于A组[（15．6±5．3）h和（26．2±6．1）h，P〈0．053；尿路刺激症状发生率：A组2．5％（9／362），B组未出现（P〈0．05）。（6）切口感染：两组均无切口感染及延期愈合的病例。（7）二次开腹手术时盆腹腔粘连情况：A组中已有3例再次剖宫产，腹直肌与筋膜层及腹膜层粘连，B组中已有2例再次剖宫产，腹直肌与筋膜层及腹膜层无粘连，此5例大网膜、腹膜、膀胱腹膜返折均无粘连。结论标准术式优于改良术式，规范化开展Stark剖宫产术，掌握操作技巧，有助于取得满意效果。

Objective To investigate the process of Stark cesarean section （CS） and analyze its key procedures and patients outcomes in order to understand its advantages and promote its standardization. Methods Elective Stark CS cases were divided into two groups according to time sequence and procedure difference. Group A refered to cases underwent modified approaches before standardization （n=362）, and group B refered to cases afterward （n= 302）. Duration of operation, time interval from incision to delivery, intraoperative hemorrhage, postoperative flatus time, postoperative morbidity, duration of retained urinary catheter, urinary tract irritation, wound infection, and abdominopelvic adhesion in the second operation were compared between the two groups. Results The average duration of the operations and time interval from incision to delivery in group B, which were （27.7 ± 10. 8） rain and （4.92 ± 1.21） rain, respectively, were significantly shorter than those in group A, which were （35.6±15.2） rain and （7. 81±2.79） rain, respectively （P〈0. 05）. No significant differences was found with regard to average intraoperative hemorrhage between group A and B [（214.3±62. 1） ml vs （201.5±53.1） ml, P〉0. 05]. Postoperative flatus time in group B was significantly shorter than that in group A [（16.8±11.8） h vs （25.9±12.7） h, P〈0. 05]. Postoperative morbidity in group B was significantly lower than that in group A [1.3%（4/302） vs 4. 7% （17/362）, P〈0.05]. The average duration of retained urinary catheter in group B was significantly shorter than that in group A [（15.6±5.3）h vs （26. 2±6.1）h, P〈0. 05], and the urinary tract irritation rate in group B was also lower than that in group A [2.5%（9/362） vs 0（0/302）, P 〈 0.05）], No incisional infection or delayed healing was found in either group. Rectus muscles, fascia and peritoneum adhesions were found in three cases with second surgery in group A and none in group B. No omentum, peritoneum and visceral peritoneum adhesion was found in either group. Conclusions Compared to the modified Stark operation, standardized procedure decreases operation associated complications and improves maternal outcomes. Therefore, standardized Stark CS should be promoted for better operative outcomes.