首次剖宫产术式对高龄孕妇再次剖宫产手术的影响

Influence of primary caesarean section on re -caesarean operation of advanced pregnant women

目的：探讨首次剖宫产术式对高龄孕妇再次剖宫产手术的影响。方法选取再次行剖宫产手术的251例孕妇作为研究对象，按首次剖宫产术式将其分为对照组（新式腹壁横切口）和研究组（传统腹壁纵切口），比较两组孕妇临床指标、腹腔粘连情况及并发症发生情况。结果研究组手术时间[（57．98±12．26）min 比（78．39±17．54）min]、术中出血量[（248．59±17．32）mL 比（377．18±56．04）mL]、肛门排气时间[（40．26±7．25）h 比（56．02±8．23）h]及住院时间[（7．21±2．06）d 比（9．94±3．13）d]均低于对照组，差异均有统计学意义（t ＝10．576、24．018、16．129、8．069，均 P ＜0．05）。研究组腹腔粘连严重程度明显较对照组轻，且差异有统计学意义（U ＝2．601，P ＜0．05）。两组新生儿均未发生窒息等严重并发症。研究组产后出血[3．03％比7．56％]及腹腔粘连[50．00％比77．31％]发生率均低于对照组，其中腹腔粘连发生率组间比较差异有统计学意义（χ2＝18．862，P ＜0．05）。结论首次剖宫产术式对高龄孕妇再次剖宫产手术临床指标、腹腔粘连严重程度及并发症均有较大影响，其中新式剖宫产术式影响更大，而传统剖宫产术式影响较小。

Objective To investigate the influence of primary caesarean section on re -caesarean operation of advanced pregnant women.Methods 251 advanced pregnant women were chosen to research,and they were divid-ed into research group（traditional abdominal longitudinal incision）and control group （novel abdominal transverse incision）by primary caesarean section.The clinical indicators,abdominal adhesion and complication occurrence between the two groups were compared.Results Operation time[（57.98 ±12.26）min vs.（78.39 ±17.54）min], amount of bleeding during operation[（248.59 ±17.32）mL vs.（377.18 ±56.04）mL],anal exhaust time[（40.26 ± 7.25）h vs.（56.02 ±8.23）h]and length of stay[（7.21 ±2.06）d vs.（9.94 ±3.13）d]of the research group were all lower than the control group,the differences were statistically significant （t =10.576,24.018,16.129,8.069,all P 〈0.05）.The severity of abdominal adhesion of the research group was lighter than the control group,and the differ-ence was statistically significant （U =2.601,P 〈0.05）.No severe complications such as asphyxia occurred in the two groups.Postpartum hemorrhage and abdominal adhesion occurrence in the research group were lower than the control group ,there was significant difference in abdominal adhesion between the two groups （χ2 =1 8 .8 6 2 ,P 〈0.05）.Conclusion Primary caesarean section has influence on clinical indicator,abdominal adhesion severity and complications in re -caesarean operation of advanced pregnant women,and novel abdominal transverse incision has greater influence,traditional abdominal longitudinal incision little.