剖宫产术后腹部切口愈合不良的原因及对策

Causes and countermeasures of poor healing of cesarean section in obstetrics and gynecology department

目的探讨妇产科剖宫产术后腹部切口愈合不良的原因及对策。方法选择2016年8月～2018年8月在北京市丰台中西医结合医院妇产科行剖宫产术,且术后切口愈合不良的患者40例为观察组,同期切口愈合良好的患者779例为对照组,分析切口愈合不良的可能原因,探讨如何能够预防切口愈合不良,加速切口愈合。结果我院剖宫产术后切口愈合不良发生率为4.88%,观察组患者手术时间为夏季、宫颈分泌物培养见致病菌、胎膜早破、孕前超重或肥胖、腹壁脂肪层厚度>3 cm、试产、皮下组织内残留线结、皮下组织使用电刀止血、术后发热者比例显著高于对照组,差异有统计学意义(P<0.05)。结论影响剖宫产切口愈合不良的相关因素为手术时间为夏季、宫颈分泌物培养见致病菌、胎膜早破、孕前超重或肥胖、腹壁脂肪层厚度>3cm、试产、皮下组织内残留线结、皮下组织使用电刀止血、术后发热,应从孕期保健、术前准备、术中操作、术后管理几个方面着手预防,发现切口愈合不良后,及时敞开切口、清除坏死组织、充分引流有利于愈合。

Objective To find out the causes and countermeasures of poor healing of cesarean section in obstetrics andgynecology department. Methods From August 2016 to August 2018, 40 patients with poor wound healing who underwentcesarean section in the Department of Obstetrics and Gynecology of Fengtai Hospital of Traditional Chinese Medicine andWestern Medicine were selected as observation group, 779 patients with good healing in the same period were the controlgroup. The possible causes of poor wound healing were analyzed and how to prevent the poor wound healing and themethods for accelerating wound healing were discussed. Results The incidence of poor wound healing after cesarean sectionwas 4.88%. In the observation group, the proportion of summer operation, pathogenic bacteria, premature rupture ofmembranes, overweight or obesity before pregnancy, abdominal adipose layer thickness 〉3 cm, trial production, residual knotsin subcutaneous tissue, use of electric knife in subcutaneous tissue and fever after operation were significantly higher thanthose in control group （P〈0.05）. Conclusions Summer operation, pathogenic bacteria, premature rupture of membranes,overweight or obesity before pregnancy, abdominal adipose layer thickness 〉3 cm, trial production, residual knots insubcutaneous tissue, use of electric knife in subcutaneous tissue and fever after operation are the common causes of poorwound healing, which should be prevented from pregnancy care, preoperative preparation, intraoperative operation andpostoperative management. When poor wound healing is found, it is important to open the incision, remove necrotic tissue,and drain sufficiently.