改良再次剖宫产的应用研究

Application of Modified Repeated Cesarean Section

目的研究并探讨改良剖宫产术在产科再次剖宫产中的应用效果。方法于2016年5月至2017年2月期间,将在我院产科接受再次剖宫产的100例产妇纳入研究,采取计算机数字随机分组方法分为两组,每组50例,对照组产妇采取传统剖宫产手术,观察组产妇采取改良剖宫产手术,比较两组产妇的手术情况、术后恢复情况、新生儿Apgar评分,并在术后3个月复查彩超,比较两组产妇的术后子宫瘢痕缺损发生率、产后恶露干净时间、产后经期时间延长率。结果观察组产妇的胎儿娩出时间、手术时间均明显长于对照组(P<0.05),其术中出血量稍增多,但差异无统计学意义(P>0.05);观察组的术后排气恢复时间、住院时间均与对照组无差异(P>0.05);观察组产妇的术后子宫瘢痕缺损发生率低(P<0.05),产后恶露干净时间较对照组短(P<0.05),产后经期时间延长率较对照组低(P<0.05);新生儿Apgar评分观察组和对照组比较无明显差异(P>0.05)。结论在再次剖宫产产妇中采取改良剖宫产术,可有效减少子宫瘢痕缺损的发生率,产后恶露干净时间缩短,还可减少经期延长的发生率,但因手术难度稍大,手术时间,胎儿娩出时间延长,术中出血稍多。

Objective To investigate the application of modified cesarean section in repeated cesarean section. Methods 100 puerperants who received repeated cesarean section in our hospital from May 2016 to February 2017 were selected and randomly divided into control group and observation group with 50 cases in each group. The control group was given traditional cesarean section,while the observation group was treated with modified cesarean section. The surgical performance,postoperative recovery,and neonatal Apgar score of both groups were compared,along with the incidence of postoperative uterine scar defect,duration of postpartum lochia,incidence of postpartum menostaxis in the reexamination with colour doppler ultrasoundand 3 months after operation. Results The delivery time and operation time of the observation group was significantly longer than those of the control group（ P〈0. 05）. However,the observation group had slightly more intraoperative blood loss than the other group,with no statistically significant difference（ P〉0. 05）. There was no difference in the postoperative evacuation time and stay length in hospital between the two groups（ P〉0. 05）.Compared with the control group,the observation group had lower incidence of postoperative uterine scar defect（ P〈0. 05）,shorter postpartum lochia time（ P〈0. 05） and lower incidence of postpartum menostaxis（ P〈0. 05）. There was no difference between the two groups in neonatal Apgar score（ P 〉 0. 05）. Conclusion The application of modified cesarean section in repeated cesarean section can effectively reduce the incidence of postoperative uterine scar defect,duration of postpartum lochia and incidence of postpartum menostaxis,but the difficulty of the operation prolongs the operation time and delivery time,and increases intraoperative blood loss.