限制会阴切开及会阴切口选择的临床探讨

Study on the Restrictive Use of Episiotomy in Spontaneously Vaginal Delivery and the Type of Episiotomy

目的:探讨限制会阴切开在头位自然分娩中的应用,比较会阴侧切与会阴正中切开两种术式母儿的结局。方法:收集2012年3～6月重庆医科大学附属第一医院产科自然分娩的586例足月单胎头位孕妇的临床资料进行回顾性分析,其中未行会阴切开196例(未行会阴切开组),行会阴侧切270例(会阴侧切组),行会阴正中切开120例(会阴正中切开组)。比较3种方式对母儿的影响。结果:在产后出血、产后住院时间、产后恢复性交时间、产后性生活满意度及产后会阴疼痛评分方面,未行会阴切开组均优于会阴切开两组,差异均有统计学意义(P<0.05),而会阴正中切开组与会阴侧切组以上指标比较,差异无统计学意义(P>0.05);3组间产褥感染、预防性使用抗生素、产后尿失禁、盆腔脏器脱垂、新生儿Apgar评分和脐血pH值两两比较,差异均无统计学意义(P>0.05)。而会阴正中切开组会阴Ⅰ～Ⅱ度裂伤率(6.67%)与会阴侧切组(1.48%)比较,有显著性升高(P<0.05)。结论:头位自然分娩过程中,在无绝对会阴切开指征时,尽量保持会阴的完整性,对母儿预后无不良影响。在有严格的会阴切开指征时,优先选择会阴侧切,降低会阴裂伤的发生。

Objective： To explore the restrictive use of episiotomy in spontaneously vaginal delivery;and to compare the effects of midline and mediolateral episiotomies on delivery. Methods：A retrospective study was conducted including 586 vaginal delivery women at ≥37 weeks of gestation with live singleton cephalic pregnancies,who were recruited from March 2012 to June 2012 in the first affiliated hospital of Chongqing Medical University,among whom 196 women were with no episiotomy,270 women were with mediolateral episiotomy,120 women were with midline episiotomy. The maternal and neonatal outcomes of three types of episiotomy were compared. Results：The postpartum hemorrhage,length of stay after childbirth,time to resuming sexual intercourse,postpartum sexual satisfaction and maximum perineal pain severity of no episiotomy were significantly decreased than midline and mediolateral episiotomy groups （ P 〈 0.05） ; at the same time there were no statistical significant differences between midline and mediolateral episiotomy groups （ P 〉 0.05）. No statistical significant differences in postnatal infection, preventive use of antibiotics, postnatal urinary incontinence, pelvic organ prolapse, neonatal apgar score and umbilical arterial pH value was found among three groups （P 〉 0.05）. 1 to R perineal tears of midline episiotomy group（6.67% ）were significantly higher than mediolateral episiotomy group （ 1.48% ） （ P 〈 0.05）. Conclusions： In the course of delivery, avoiding routine episiotomy in unnecessary conditions would increase the rate of intact perineal with no adverse effects on maternal and neonatal morbidities. To reduce perineal trauma,a mediolateral rather than midline approach when episiotomy is indicated is prioritizing.