二次剖宫产术时盆腹腔粘连分析

Analysis of pelvic and peritoneal adhesion during the second cesarean section

目的:分析二次剖宫产术时盆腹腔粘连发生的危险因素并提出防范措施。方法:回顾性收集2018年5月—2020年9月在本院行二次剖宫产术的瘢痕子宫患者临床资料,剖宫产术中有盆腹腔粘连75例为粘连组,未见粘连75例为无粘连组。采用多因素logistic回归分析影响剖宫产术盆腹腔粘连的相关因素。结果:瘢痕子宫二次手术中盆腹腔粘连与剖宫产时机、首次剖宫产宫口开大程度无关(P>0.05),与两次剖宫产间隔时间、年龄、手术切口类型、羊水污染及其污染程度等有关(P<0.05)。且盆腹腔粘连严重程度与剖宫产术中出血量、术后感染、手术时间、住院时间、新生儿窒息、开腹至胎儿娩出时间等有关(P<0.05)。羊水污染及其污染程度高、原手术切口横切口、两次剖宫产间隔时间<2年、年龄≥35岁是导致瘢痕子宫二次手术中有盆腹腔粘连的独立危险因素(P<0.05)。结论:临床应关注导致剖宫产瘢痕子宫盆腹腔粘连发生的可能因素,通过降低剖宫产次数、预防羊水污染、选择纵向切口等加以预防。

Objective:To analyze the risk factors pelvic and peritoneal adhesion and preventive measures of women with scar uterus during the second cesarean section.Methods:The clinical data of the women with scar uterus who underwent the second cesarean section from May 2018 to September 2020 were collected retrospectively.75 women with pelvic and peritoneal adhesion found during the second cesarean section were in study group,and 75 women without pelvic and peritoneal adhesion found during the second cesarean section were in control group.Multivariate Logistic regression analysis was used to analyze the related factors affecting pelvic and peritoneal adhesion after the first cesarean section.Results:the pelvic and peritoneal adhesions of the women found during the second cesarean section were not related to the timing of the first cesarean section or the degree of cervical opening before the first cesarean section(P>0.05),but were correlated with the interval between the two cesarean sections,age,incision type,amniotic fluid pollution and its pollution degree(P>0.05).The severity of pelvic and peritoneal adhesions was related to the amount of blood loss during cesarean section,postoperative infection,operation time,hospital stay,neonatal asphyxia,and the time from began operation to delivery(P<0.05).Multivariate logistic regression analysis showed that amniotic fluid contamination and high degree of contamination,transverse incision of the first cesarean section,interval of the two cesarean sections<2 years,and≥35 years old were the independent risk factors of pelvic and peritoneal adhesions(P<0.05).Conclusion:The possible factors that lead to pelvic and peritoneal adhesion of the women with scar uterus after cesarean section should be paid attention to in clinic.And proactive measures should be taken to protect the health of pregnant women and fetus by reducing the number of cesarean section,prevent amniotic fluid pollution,choose longitudinal incision during cesarean section,and so on.