三种剖宫产术对再次剖宫产的影响

目的探讨三种不同剖宫产术式对再次剖宫产的影响。方法采用前瞻分析的方法 ,对我院产科2004年4月-2009年3月再次剖宫产279例的术中、术后进行观察,其首次剖宫产I组子宫下段剖宫产65例,Ⅱ组新式剖宫产86例,Ⅲ组改良新式剖宫产128例,比较三组再次剖宫产手术时间、出血量、肛门排气时间、盆腹腔粘连情况及术后情况。结果再次剖宫产时新式剖宫产与子宫下段剖宫产和改良新式剖宫产在腹壁及盆腹腔粘连、切开腹壁至暴露子宫下段的出血量差异有统计学意义(P0.05),而子宫下段剖宫产与改良新式剖宫产差异无统计学意义(P0.05),切开腹壁暴露子宫下段时间、原手术疤痕缺损发生率依次为改良新式剖宫产、子宫下段剖宫产、新式剖宫产,差异有统计学意义(P0.05)。结论改良新式剖宫产吸取了新式剖宫产手术时间短、产妇疼痛轻、术后肛门排气快、恢复快的优点,是值得推广的选择术式。

Effects of Three Different Methods of Cesarean Section on the Second-time Cesarean Section

Objective To evaluate the impact of three different methods of cesarean section （CS） on the secondtime cesarean section. Methods Prospective analysis method was used in this study. Totally 279 cases of the secondtime cesarean section in Department of Obstetrics of The People＇ s Hospital of Ningxiang County from April, 2004 to March, 2009 were observed before and after operation. The cases were divided into three groups： uterine lower segmental CS （group Ⅰ, n =65）, new mode CS （group Ⅱ, n=86）, and new modified CS （group Ⅲ, n= 128）. The operation time, blood loss, anal exsufflation time, abdominal and pelvic adhesion, and postoperative condition were compared among the three groups. Results There were statistically significant differences in abdominal and pelvic adhesion and blood loss in opening the abdominal wall to exposing the lower uterine segment between new mode CS and uterine lower segmental CS, new modified CS （P 〈0.05）, while no statistically significant difference was found between uterine lower segmental CS and new modified CS （P 〉0.0.5）. The time of opening the abdominal wall to exposing the lower uterine segment and the incidence rate of original scar defect were in order of new modified CS, uterine lower seffnental CS, and new mode CS, and the difference was statistically significant （P〈 0.05）. Conclusions The new modified CS absorbs the advantages of short operation time, mild pain, fast anal exhaust, and quick recovery. It is worthy to be popularized in clinic.