剖宫产子宫切口缝合方法与子宫切口憩室的关系

Relationship between suturing method of uterine incision after cesarean section and uterine incision diverticula

目的分析不同剖宫产子宫切口缝合方式与子宫切口憩室之间的关系。方法选择2014年9月~2016年9月在我院产科接受剖宫产手术的患者88例,以随机数字表法将其分为对照组和研究组,每组44例。对照组采用单层连续缝合方式实施子宫切口缝合;研究组采用第一层用可吸收线连续缝合子宫肌层内1/3,第二层用可吸收线褥式缝合子宫肌层外2/3,第二层不缝合膀胱反折,第三层连续缝合膀胱反折。比较两组产妇子宫切口憩室形成例数、对剖宫产切口缝合方案的满意度、术后肛门排气时间、术后恶露持续时间、术后住院治疗总时间,以及产后不同时间段的血红蛋白水平的改善幅度。结果研究组患者剖宫产手术后仅有1例(2.3%)形成子宫切口憩室,少于对照组的7例(15.9%),差异有统计学意义(P<0.05);对剖宫产切口缝合方案的满意度达到95.5%,高于对照组的77.3%,差异有统计学意义(P<0.05);术后肛门排气时间、恶露持续时间、住院治疗总时间短于对照组,差异有统计学意义(P<0.05);产后不同时间段的血红蛋白水平的改善幅度大于对照组,差异有统计学意义(P<0.05)。结论剖宫产手术产妇采用三层连续缝合方式对切口进行缝合,可以有效减少子宫切口憩室事件的发生,缩短术后恢复时间,保证围产期阶段产妇安全。

Objective To analyze the relationship between different suturing method of uterine incision after cesarean section and uterine incision diverticula.Methods 88 patients who were given cesarean section in the Department of Obstetrics in our hospital from September 2014 to September 2016 were selected.The patients were divided into control group and study group according to the random number table,44 cases in each group.The control group was given single-layer continuous suture to implement uterine incision suturing.The study group was given absorbable line at the first layer to continuous suture the inner one third part of myometrium.Absorbable line at the second layer was used to mattress suture the outer one third part of myometrium;the third layer was used to continuously suture bladder reflex.The second layer was not used to suture bladder reflex.The number of cases with uterine incision diverticula,the satisfaction rate of incision suture protocol,the time of postoperative anal exhaust,the duration of postoperative lochia,the total time of postoperative hospitalization,and the improvement of hemoglobin level in different time periods after delivery were compared between the two groups.Results Only one case（2.3%） in the study group formed uterine incision diverticula after the surgery of cesarean section,less than 7 cases in the control group（15.9%）,and the difference between groups was significant（P〈0.05）;the satisfaction rate of cesarean section incision protocol was 95.5%,which was higher than that of 77.3% in the control group,the difference between groups was significant（P〈0.05）;the duration of postoperative anal exhaust,duration of postoperative lochia and total time of postoperative hospitalization were shorter than those in control group,the differences between groups were significant（P〈0.05）;the improvement of hemoglobin level in different time periods after the surgery was higher than that in the control group,and the difference was significant（P〈0.05）.Conclusion Three-layer continuous suture is applied to suture the incision for the puerpera after cesarean section,which is effective to reduce the incidence of uterine incision diverticulum,shorten the postoperative recovery time and ensure the safety of puerpera during perinatal period.