瘢痕子宫二次剖宫产60例分析

Analysis on 60 Cases of Scarred Uterus with Secondary Cesarean Section

目的探讨瘢痕子宫二次剖宫产的临床特点。方法选择青川县人民医院2009年1月-2011年1月收治的行二次剖宫产的产妇60例,随机依据首次剖宫产采用的不同术式资料进行回顾性分析。结果手术总时间及手术开始至胎儿娩出时间横切口组长于纵切口组,术中出血量横切口组多于纵切口组,差异有统计学意义(P<0.05)。两组在腹腔粘连方面差异有统计学意义(P<0.05),再次剖宫产横切口与纵切口比较,均愈合良好29例,愈合不良1例,合并前置胎盘7例,其中中央性4例,广泛植入2例,经各种处理无效后行子宫切除术。无产妇死亡。早产儿死亡2例,余全部存活。结论瘢痕子宫行第二次剖宫产术时,产科医生手术操作应娴熟,以保证手术安全。降低剖宫产率需加大宣传力度,使患者对手术风险有足够的认识,并充分进行试产,以使二次剖宫产率降低。

Objective To explore the clinical characteristics of scarred uterus with secondary cesarean section. Methods Sixty pregnant women with scarred uterus performed secondary cesarean section in the People＇s Hospital of Qingchuan County from January 2009 to January 2011 were enrolled in this study.According to different surgical methods in the first cesarean section,the clinical data of 60 pregnant women were retrospectively analyzed. Results The total operation period,the mean time from the incision to fetal delivery,and intraoperative blood loss in transverse incision group were more than those in longitudinal incision group,and the difference was statistically significant between the two groups（P〈0.05）.There were statistically significant differences in peritoneal adhesion between the two groups（P〈0.05）.We compared the clinical outcomes of transverse incision group with longitudinal incision group in the secondary cesarean section,and the results showed that 29 cases were healed and 1 case had poor healing.7 cases had placenta previa,including 4 cases of central placenta previa and 2 cases of widely implanted placenta previa,and hysterectomy was performed after the various ineffective treatments.No maternal death was found.2 premature infants died,and the others survived. Conclusions The obstetricians should be skilled in performing secondary cesarean section among pregnant woman with scarred uterus in order to ensure operation safety.It is necessary to enhance the related propaganda,let the patients knowing about sufficient knowledge about surgical risks,and carry out trial of vaginal delivery so as to reduce the rate of secondary cesarean section.