改良式腹部横切口妇科手术25例分析

An analysis or 25 cases with modified gynecologic abdominal transverse incision

目的 探讨改良式腹部横切口妇科手术与传统的腹部纵切口在手术指征、术中出血、术后恢复及切口愈合等方面的差异。方法在下腹耻骨联合上２ｃｍ（即腹壁半环线上２ｃｍ）横行直线切开皮肤１０～１５ｃｍ，钝性撕开脂肪，剪开浅筋膜，钝性分开腹直肌，钝性上下方向撕开腹膜，子宫切除，附件切除，或次广泛切除子宫，手术步骤不变。当盆腔腹膜缝合完毕，不缝合壁层腹膜，用０／２薇乔线从左向右连缝合筋膜及１／３腹壁脂肪，折回褥式皮内缝合皮肤，术后不拆线。结果 术后排气时间由原来的４８±５ｈ缩短至１２±５ｈ（Ｐ＜０．０１），术后疼痛时间由原来的２４±５ｈ缩短至８±５ｈ，切口均Ｉ期愈合。结论此术式优于传统的纵切口，手术方法易于掌握，值得推广。

Objective To explore the difference between the improved gynecological operations and traditional abdominal longitudinal incision in terms of operation indicators,hemorrhage in operation, postoperative recovery and healing of incision. Methods Making a 10 - 15cm transversal incision 2cm above the pubic symphysis. bluntly tearing the fat ant cut the fascia with scissors,bluntly separating the rectus abdominis,bluntly and longitudinally tearing the peritonm and excising the uterus and its appendix. Continuously suturing the fascia,the 1/3 portion of the abdominal fat and the skin with 0/2 vicryl suture without suturing peritoneum parietal. After opertion, there is no need to remove the abdominal stitches. Results The time of postoperative exsufflation decreased from 48+5h to 12 + 5h (P<0. 01) and the time of postoperative pain decreasd from 24±5h to 8±5h. All incisions healed by first intention. Conclusion The modified gynecologic abdominal transverse incision is superior to the traditional longitudinal incision,which is easy to master and worth populaizing.