二次剖宫产子宫切口不同方式的临床效果对比研究

Comparative Study on the Clinical Effect of Different Methods of Uterine Incision in Second Cesarean Section

目的探究二次剖宫产孕妇子宫切口应用不同方式的临床效果。方法自该院2018年1月—2019年12月收治的足月妊娠孕妇中,方便抽选出存在剖宫产手术史孕妇80例作为观察对象,按剪开膀胱子宫反折与否,将80例孕妇随机分为对照组(40例)与观察组(40例),其中对照组孕妇需剪开膀胱子宫反折、下推膀胱,于子宫下段肌层瘢痕切口上1 cm作一小切口,由该切口横向撕开并娩出胎儿;观察组孕妇无需剪开膀胱子宫反折,仅需在原有瘢痕切口上1 cm作一小切口后横向剪开并娩出胎儿。观察两组治疗效果。结果对照组孕妇手术时间(51.13±7.00)min、术中出血量(352.42±23.54)mL,显著高于观察组的(43.68±5.45)min、术中出血量(151.41±13.42)mL(t=5.311、46.920,P<0.05)。对照组孕妇发生子宫切口撕裂、胎头娩出受阻情况分别为8例(20%)、6例(15%),明显多于观察组(χ~2=6.806、4.505,P<0.05)。对照组孕妇发生膀胱损伤情况为6例(15%),明显多于观察组,差异有统计学意义(χ~2=4.505,P<0.05)。结论瘢痕子宫二次剖宫产手术无需对膀胱子宫反折予以剪开,仅需在原瘢痕切口上1 cm作一小切口后横向剪开并娩出胎儿,该方式相比于剪开膀胱子宫反折方式,在缩短了手术时间的同时,胎头娩出受阻率、切口延长率也较低,临床应用效果也较好,建议推广应用。

Objective To explore the clinical effects of different methods of uterine incision in pregnant women with the second cesarean section.Methods Among the full-term pregnant women admitted to the hospital from January 2018 to December 2019,80 pregnant women with a history of cesarean section were conveniently selected as observation objects;according to whether the bladder and uterus were reflexed or not,80 pregnant women were randomly divided into a control group(40 cases)and an observation group(40 cases);the pregnant women in the control group need to cut the bladder and uterus,push down the bladder,and make a small incision 1cm on the incision of the lower uterine muscle layer.The fetus was torn and delivered;the pregnant women in the observation group did not need to cut the bladder and the uterus,but only needed to make a small 1cm incision on the original scar incision and then cut it laterally and deliver the fetus.To obsserved the theatment effect of the two groups.Results The operation time(51.13±7.00)min and intraoperative blood loss(352.42±23.54)mL were significantly higher in the control group than those in the observation group with operation time(43.68±5.45)min and intraoperative blood loss(151.41±13.42)mL(t=5.311,46.920,P<0.05).In the control group,8 cases(20%)and 6 cases(15%)of the pregnant women had uterine incision laceration and obstruction of fetal head delivery,respectively,which were significantly higher than those in the observation group(χ2=6.806,4.505,P<0.05).The incidence of bladder injury in the control group was 6 cases(15%),significantly higher than that in the observation group,the difference was statistically significant(χ2=4.505,P<0.05).Conclusion The second cesarean section of scar uterus does not need to cut open the vesico-uterine peritoneal reflection.It only needs to make a small incision around 1cm above the original scar and tear transversely to give birth.At the same time,the operation time is shortened,the obstruction rate and incision lengthening rate of fetal head delivery are also lower,and the clinical application effect is also better.It is worthy to be widely applied.