剖宫产手术发生子宫切口裂伤的影响因素及预防对策

Analysis of factors affecting uterine incision laceration in cesarean section surgery and the prevention measures

目的探讨影响剖宫产手术发生子宫切口裂伤的因素,以采取相应的预防对策。方法收集2014~2015年成都市第二人民医院妇产科采取剖宫产分娩的1 762例产妇的临床资料,分析影响剖宫产手术发生子宫切口裂伤的因素。结果子宫切口裂伤81例,占4.60%。经Logistic回归分析,宫口扩张≥8 cm、术前先露S≥+3、枕后位、子宫下段形成差、瘢痕子宫、新生儿体重≥4 kg、胎位为臀位是影响剖宫产手术发生子宫切口裂伤的独立因素。在切口位置上,当切口距离膀胱子宫返折>3 cm时,裂伤率高于<3 cm时的距离(P<0.05);而在扩大子宫切口方式上,钝性切口裂伤率远高于采用钝性加锐性切口的裂伤发生率(P<0.05)。结论剖宫产手术切口裂伤发生与手术时机、先露位置、子宫手术史、胎儿体重、胎方位、切口位置、手术技巧相关,剖宫产术前应充分评估胎儿体重,产时及时纠正胎位不正及胎方位,把握手术时机,严格掌握剖宫产指征,提高手术技巧,以减少剖宫产术子宫切口裂伤的发生。

Objective To analyze the risk factors and preventive measures of uterine incisional dehiscence in cesarean section. Methods From January 2014 to December 2015, the clinical data of 1 762 patients with cesarean sections were retrospectively analyzed in Chengdu Second People ＂s Hospital in order to find factors affecting the occurrence of uterine incision laceration in cesarean section. Results Uterine incision laceration occured in 81 cases, accounting for 4. 60 %. The logistic regression analysis showed, cervix dilatation i〉 8 em, preoperative presentation S i〉 ＋ 3, posterior occipital position, poor lower uterine segment formation, scar uterus, neonatal weight 〉I 4 kg and fetal breech position were independent factors of uterine incision laceration. About the incision position, when the incision was more than 3 cm from the bladder uterus, the rate of laceration was higher than that of 〈 3 cm （ P 〈 0.05 ）. The rate of laceration of blunt incision was much higher than that of sharp incision（ P 〈 0. 05 ）. Conclusion Cesarean section incision laceration is related to surgical timing, presentation position, uterine surgery history, fetal weight, fetal position, incision location and surgical techniques. With fetus weight fully assessed, fetal position timely corrected, the timing of surgery grasped,cesarean section indications strictly controled, and surgical skills improved, the occurrence of uterine incision laceration of cesarean section will be reduced.