首次腹部横切口与纵切口剖宫产对再次剖宫产患者盆腹腔粘连程度、术中情况及腹壁瘢痕的影响

Impact of the first mouth abdominal transverse and longitudinal incision cesarean section in patients with cesarean section again basin celiac adhesion degree,intraoperative situation and abdominal wall scar

目的 探讨首次腹部横切口与纵切口剖宫产对再次剖宫产患者盆腹腔粘连程度、术中情况及腹壁瘢痕的影响。方法 选取本院妇产科2009年1月~2014年2月收治的104例再次剖宫产产妇,根据产妇首次剖宫产方式的不同进行分组。其中研究组56例,首次剖宫产选择纵切口术式;对照组48例,首次剖宫产选择横切口术式。记录两组产妇的盆腹腔粘连程度、腹壁瘢痕及再次剖宫产术中情况。结果 研究组首次剖宫产术后大网膜粘连3例,腹腔粘连5例,膀胱腹膜返折粘连2例,发生率为17.9%（10/56）;对照组大网膜粘连7例,腹腔粘连10例,膀胱腹膜返折粘连7例,发生率为50.0%（24/48）,差异有统计学意义（P〈0.05）。研究组首次剖宫产术后腹壁出现纤细瘢痕为39例（69.6%）,中等瘢痕12例（21.4%）,明显瘢痕5例（9.0%）,对照组分别为21例（43.8%）、18例（37.5%）、9例（18.7%）,差异有统计学意义（P〈0.05）。研究组产妇手术总时间为（44.2±6.4）min,术中出血量为（256.3±31.8）ml,开腹至胎儿娩出时间为（7.9±1.1）min,对照组分别为（55.3±7.1）min、（298.0±42.7）ml、（10.7±1.8）min,差异均有统计学意义（P〈0.05）。结论 首次剖宫产产妇选择纵切口术式能够降低盆腹腔粘连程度,并降低再次剖宫产的手术风险和损伤情况。

Objective To explore the impact of the first mouth abdominal transverse and longitudinal incision cesarean section in patients with cesarean section again basin celiac adhesion degree,intraoperative situation and abdominal wall scar. Methods 104 maternal with cesarean section again in department of obstetrics and gynecology of our hospital from January 2009 to February 2014 were selected and divided into groups according to the different way of maternal cesarean delivery for the first time.Among them,the study group in 56 cases,chose longitudinal incision cesarean section for the first time.The control group in 48 cases,chose cesarean section crosscutting port operation for the first time.The abdominal cavity adhesion degree, abdominal wall scar and again in cesarean section in two groups of maternal were recorded. Results The greater omentum adhesion in 3 cases,intraperitoneal adhesion in 5 cases,bladder peritoneum reflected adhesions in 2 cases,the incidence was 17.9% （10/56） in study group of cesarean section for the first time.The greater omentum adhesion in 7 cases,abdominal cavity adhesion in 10 cases,bladder peritoneum reflected adhesion in 7 cases,the incidence was 50.0% （24/48） in control group,the difference was statistically significant （P〈0.05）.The abdominal wall appeared thin scar in 39 cases （69.6%）,medium scar in 12 cases （21.4%）,obvious scar in 5 cases （9.0%） in study group of cesarean section for the first time.The Thin scar in 21 cases （43.8%）,medium scarring in 18 cases （37.5%）,and obvious scar in 9 cases （18.7%） in control group,the difference was statistically significant （P〈0.05）.The maternal total operation time were （44.2±6.4） min, intraoperative blood loss was （256.3±31.8） ml,open to fetal childbirth time was （7.9±1.1） min in study,the control group were （55.3±7.1） min,（298.0±42.7） ml,（10.7±1.8） min respectively,the difference was statistically significant （P〈0.05）. Conclusion The first cesarean section choice longitudinal incision operation can reduce maternal abdominal adhesions,and reduce the operation risk and damage situation of cesarean delivery again.