二次剖宫产术的临床分析

Clinical analysis of caesarean operation for the second time

目的探讨不同剖宫产术式的利弊,以期改良现有手术方式,减少或减轻并发症的发生。方法选择腹壁横切口剖宫产术后再次剖宫产58例为研究组,其中改良新式剖宫产28例为A组,新式剖宫产30例为B组,腹壁纵切口剖宫产32例为C组,二次手术均为子宫下段剖宫产,对比三组开腹至胎儿取出时间、手术总时间、腹腔粘连情况、术中总出血量。结果研究组与对照组开腹至胎儿取出时间及腹腔粘连差异均有显著性,而术中出血量及总手术时间差异无显著性。结论新式剖宫产不缝合壁层腹膜可使腹直肌与子宫致密粘连,导致再次手术进腹时分离粘连时间长,腹直肌损伤大,粘连较传统子宫下段剖产术严重,给再次手术增加了难度,通过新式剖宫产术壁层腹膜缝合的改良,不但保留了新式剖宫产的优点,而且阻断了腹直肌与子宫切口的粘连,特别是不扰乱和损伤膀胱,不给再次剖宫产带来困难,是一种很好的新式剖宫产改良术。腹壁纵式手术切口创伤小,再次手术操作简单,进腹时间短,对有二胎指标可能再次行剖宫产手术的患者,也是一种明智的选择。

Objective To explore the advantage and disadvantage of different caesarean sections, in order to improve the patterns of existing surgery and reduce complication. Methods Cohort study with prospectively collected data from those of 58 who have undergone caesarean section with transverse incision at the abdominal wall, and re-delivery with lower segment cesarean seetion,A for 28 of New Modified Cesarean Section, B for 30 of new mode caesarean section, C for 32 of classic caesarean section. Compare the indexes of time from open to have fetus takeout, total time of the operation, abdominal adhesions after operation, and the bleeding volume during operation. Results The time from open to have fetus takeout and abdominal adhesions after operation were statistically significant in the repeated caesarean section patients compared with the control group, and no difference in the time of whole operation and the bleeding volume. Conclusion In new mode caesarean section, peritonaeum of parietal layer is not sutured, so that rectus abdominis muscles and uterus are easily adhesions densely. It takes more time to separate adhesion and more severe damage on rectus abdominis, when in the operation of re-delivery. The difficulty increases. New modified cesarean section preserves the advantage of new mode CS, and improves the disadvantages. It blocks adhesions, decreases the injury of bladder and makes re-CS much more easy. Surgery of slitting incision at the abdominal wall has light surgical trauma, short time before delivery, and makes reoperation easier. Therefore, for those who may have the second births, it is worthy to be chose.