瘢痕子宫腹腔粘连危险因素分析及对再次剖宫产的影响

Risk factors of abdominal adhesions in scarred uterus and its influence on cesarean re-operation

目的探讨瘢痕子宫患者发生腹腔粘连的危险因素以及对再次剖宫产术的影响。方法选择马鞍山十七冶医院2013年6月至2015年12月263例瘢痕子宫剖宫产产妇中存在腹腔粘连的78例患者为粘连组,同期接受子宫下段剖宫产术术中未见腹腔粘连的78例孕妇为无粘连组,采用多因素Logistic回归分析在年龄、两次剖宫产时间间隔、上次剖宫产医院级别、手术切口方式、既往盆腔炎史、其他腹腔手术史、多次剖宫产史、妊娠期高血压疾病等因素中确认导致瘢痕子宫剖宫产术腹腔粘连危险因素,并比较两组患者术中相关情况。结果上次剖宫产医院级别低于二甲,原手术切口为横切口,盆腔炎史和既往多次剖宫产史为瘢痕子宫剖宫产术腹腔粘连的危险因素。粘连组手术时间、术中出血量明显增加(P<0.05),新生儿取出困难、新生儿窒息、周围组织损伤发生明显增多(P<0.05)。结论临床上应重视上次剖宫产医院级别,原手术切口方式,盆腔炎史及多次剖宫产史等瘢痕子宫腹腔粘连危险因素的识别,做到提前预防,积极应对,以降低对再次剖宫产的影响。

Objective To discuss risk factors that may lead to abdominal adhesions among patients with scarred uterus and their impacts on re - operation of cesarean. Methods 78 abdominal adhesion cases diagnosed out of 263 cesarean parturients with scarred uterus in Seventeenth Metallurgy Hospital of Maanshan from June 2013 to December 2015 were selected as adhesion group. 78 parturients without abdominal adhesions during the same time were selected as no adhesion group. Multi - factor logistic regression analysis was applied to confirm the critical factors lead to abdominal adhesions including age, time interval between two cesarean operations, the grade of hospital of the previous operation, type of incision, medical record of pelvic inflammation, medical record of other abdominal operation, history of repeatedly cesarean operations, high blood pressure during pregnancy, and the condition during operation of the two groups were compared correspondently. Results The previous cesarean operation done in a hospital grading lower than second - senior, transverse incision in operation and history of pelvic infection and repeatedly cesarean operations were risk factors of abdominal adhesions among patients with scarred uterus. Operation time, bleeding amount during operation of adhesion group increased than no adhesion group（ P 〈 0. 05 ）, the new -borns were more difficult to take out, and chances for neonatorum asphyxia and surrounding tissue damage also increased （ P 〈 0. 05 ）. Conclusion The grade of hospital of the previous cesarean operation, the previous operation incision as well as the medical record for pelvic inflammation and repeatedly cesarean operations deserve high clinical attention. Advance precautions and active treatment should be done to lower the negative influence on the cesarean re -operation .