剖宫产术式对再次妇产科手术的影响

目的探讨不同剖宫产手术方式对再次妇产科手术的影响。方法1999年1月至2006年12月实施再次妇产科手术的患者128例,其中初次剖宫产术为改良新式剖宫产（观察组）56例,新式剖宫产（对照一组）38例,传统子宫下段剖宫产（对照二组）34例。结果三组再次术后切口并发症发生率、切口一期愈合率相似,差异无显著意义（P〉0.05）。观察组平均手术时间为（50.3±20.3）min,明显短于对照二组的（66.9±24.5）min（P〈0.01）,但与对照一组的（55.5±25.3）min比较无差异（P〉0.05）;盆腹腔粘连发生率观察组为7.1%,明显低于对照一组（34.2%）和对照二组（35.3%）（P〈0.01）;重度粘连发生率观察组为0,明显低于对照一组（10.5%）（P〈0.01）,但与对照二组（5.9%）比较无差异（P〉0.05）。结论改良新式剖宫产对再次妇产手术影响最小,值得临床推广应用。

Influence of Cesarean Section Procedures on Gynecological and Obstetric Reoperation

Objective To discuss the influence of different procedures of cesarean section on gynecological and obstetric reoperation. Methods During January 1999 to December 2006, 128 women with cesarean section history were performed open surgery again. The previous procedures were new modified cesarean section in 56 cases （observation group）, new cesarean section in 38（ 1st control group）, and traditional low segment cesarean section in 34 （2nd control group）. The mean operative time, wound complication incidence, wound healing rate, and pelvic-abdominal cavity adhesion rate were compared among the three groups. Results There was no difference of postoperative wound complication rate and healing rate among the three groups （ P 〉 0. 05 ）. The mean operative time was （50.3 ±20.3） min, （55.5 ±25.3）min and （66.9 ±24.5）min in observation control group, 1 st control group and 2nd control group respectively. The mean operative duration of observation group was shorter than that of 2nd control group（P 〈0.01 ）, but no difference between observation group and 1st control group（ P 〉 0. 05 ）. The pelvic-abdominal cavity adhesion rate of observation group was 7.1%, and obviously lower than 34.2% of 1 st control group and 35.3 % of 2nd control group （P 〈 0. 01 ）. The severe adhesion rate of observation and 2nd control group was 0 and 5.9% respectively, both of them were lower than 10.5% of 1st control group （ P 〈 0. 01 ）. Condusion The influence of new modified cesarean section is slightest to reoperation among the three procedures, and it is deserved to be popularized.