首次剖宫产妇采用不同腹壁切口对再次剖宫产手术的影响

Effect of different abdominal wall incisions on re cesarean section in first cesarean section

目的探讨首次剖宫产(Cesarean section,CS)不同腹壁切口对再次剖宫产手术的影响.方法选取天津医科大学宝坻临床学院2018年4月-2021年8月收治的76例二次CS术产妇,以其前次CS术中腹壁切口为标准分组,观察组(纵向腹壁切口组,38例)和对照组(横向腹壁切口组,38例).两组产妇均接受CS术分娩,其中观察组产妇前次CS术中腹壁切口为纵向切口,此次做腹壁纵向切口;对照组前次CS术中腹壁切口为横向切口,此次手术中做腹壁横向切口.分析比较两组产妇的常规手术指标,包括CS术的总时间、切皮到胎儿娩出用时以及术中出血量;统计两组母婴并发症情况,包括新生儿窒息、产妇盆腹腔粘连等.结果观察组产妇的CS术总时间、切皮到胎儿娩出用时、术中出血量均短于/少于对照组,且P<0.05.观察组的新生儿窒息率为5.26%,对照组为18.42%,且P<0.05;观察组产妇的盆腔粘连发生率为15.79%,对照组为31.58%,且P<0.05.结论首次CS产妇选择横向腹壁切口,容易对再次CS术产生影响并增加母婴并发症率.

Objective To investigate the effect of different abdominal wall incisions in the first cesarean section(CS)on the second cesarean section.Methods Seventy six parturients who underwent secondary CS surgery in Baodi Clinical College of Tianjin Medical University from April 2018 to August 2021 were selected,and their abdominal wall incision during the previous CS surgery was taken as the standard gi'oup(longitudinal abdominal incision group,38 cases)and control group(transverse abdominal incision group,38 cases).Both groups of parturients received CS operation for delivery.In the observation group,the abdominal wall incision in the previous CS operation was longitudinal incision,and the abdominal wall longitudinal incision was made this time;in the control group,the abdominal wall incision in the previous CS operation was transverse incision,and the abdominal wall transverse incision was made in this operation.The routine operation indexes of the two groups were analyzed and compared,including the total time of CS,the time from skin cutting to fetal delivery and the amount of intraoperative bleeding;the maternal and infant complications of the two groups were counted,including neonatal asphyxia,maternal pelvic and abdominal adhesion,etc.ResuIts The total time of CS operation,the time from skin cutting to fetal delivery and the amount of intraoperative bleeding in the observation group were shorter/less than those in the control group(P<0.05).The neonatal asphyxia rate was 5.26%in the observation group and 18.42%in the control group(P<O.O5);the incidence of pelvic adhesions was 15.79%in the observation group and 31.58%in the control group(P<0.05).Conelusion The choice of transverse abdominal incision for the first time CS pregnant women is easy to affect the second CS operation and increase the rate of maternal and infant complications.