超声评估医用防粘连膜预防剖宫产术后切口粘连的应用研究

Application of ultrasound assessment of medical anti-adhesion membrane in the prevention of incision adhesions after cesarean section

目的探讨超声评估医用防粘连膜预防剖宫产术后切口粘连的临床应用价值。方法选取2011年1月至2012年7月我院收治的自愿主动要求剖宫产及有剖宫产指征的孕妇300例,按产程不同分为3组:未临产剖宫产组、第一产程剖宫产组、第二产程剖宫产组。剖宫产均采用子宫下段剖宫产。各组孕妇又随机分为治疗组和对照组各50例(分别共150例),治疗组将医用防粘连膜(壳聚糖膜)覆盖于子宫下段切口周围及与腹壁切口相对应的子宫表面和附近肠管表面;对照组未放置医用防粘连膜,术后常规关腹。比较各组间的术后切口粘连率与子宫下段前壁切口愈合情况。结果治疗组发现术后切口粘连1例,发生于未临产剖宫产组;对照组术后切口粘连37例,其中未临产剖宫产组18例,第一产程剖宫产组7例,第二产程剖宫产组12例。两组差异有统计学意义(P<0.05或P<0.01)。治疗组子宫下段切口愈合总有效率为98.00%,明显优于对照组的74.67%,差异有统计学意义(P<0.05)。结论医用防粘连膜能有效地防止剖宫产术后腹壁粘连,同时所需费用少,患者无痛苦,又能明显改善生活质量,广泛应用后将产生巨大的社会效益和经济效益。

Objective To investigate the application value of ultrasound assessment of medical anti-adhesion membrane in the prevention of incision adhesions after cesarean section. Methods Three hundred pregnant women scheduled for cesarean section and with indications of cesarean section from January 2011 to July 2012 in our hospital were divided into three groups according to birth process： group A （n=100）, group B （n=100）, group C （n= 100）, which applied cesarean section before stage of labor, in the first stage of labor, and in the second stage of labor,respectively. Each group were further divided into the treatment group （50 cases each, a total of 150 cases） and the control group （50 cases each, a total of 150 cases）. In the treatment group, medical anti-adhesion film （chitosan fill） was covered in the lower uterine segment incision around the surface of the corresponding uterus and abdominal incision and intestinal surface. In the control group, medical anti-adhesion film was not placed, and conventional abdominal closure was performed. Postoperative wound adhesion rate and the wound healing of lower uterine segment anterior wall were compared between the groups. Results In the treatment group, one case of postoperative wound adhesions was found in the group A. In the control group, 37 cases of postoperative wound adhesions were found, including 18 cases in group A, 7 cases in group B, and 12 cases in group C. The difference was statistically significant （P〈0.05 or P〈0.01）. The lower uterine segment incision healing efficiency of the treatment group was 98.00%, significantly better than 74.67% of the control group （P〈0.05）. Conclusion Medical anti-adhesion fill can effectively prevent abdominal adhesions after cesarean section, with less cost, no pain, and can significantly improve the quality of life, which can generate enormous social and economic benefits after widely application.