超声评估医用防粘连膜预防剖宫产术后切口粘连的应用研究

目的探讨超声评估医用防粘连膜预防剖宫产术后切13粘连的临床应用价值。方法选取2011年1月～2012年7月广东省深圳市龙华人民医院收治的自愿主动要求剖宫产及有剖宫产指征的孕妇300例，按产程不同分为未临产剖宫产组、第一产程剖宫产组、第二产程剖宫产组。剖宫产均采用子宫下段剖宫产。各组孕妇又随机分为治疗组和对照组各50例（分别共150例），治疗组将医用防粘连膜（壳聚糖膜）覆盖于子宫下段切13周围及与腹壁切13相对应的子宫表面及附近肠管表面；对照组未放置医用防粘连膜，术后常规关腹。比较各组间的术后切口粘连率与子宫下段前壁切13愈合情况。结果治疗组发现术后切口粘连1例，对照组术后切口粘连37例。其中未临产剖宫产组18例，第一产程剖宫产组7例，第二产程剖宫产组12例。两组差异有统计学意义（P〈0．05或P〈0．01）。治疗组子宫下段切口愈合总有效率为98．00％，明显优于对照组的74．67％，差异有统计学意义（P〈0．05）。结论医用防粘连膜能有效地防止剖宫产术后腹壁粘连，同时所需费用少，患者无痛苦，又能明显改善生活质量，广泛应用后将产生巨大的社会效益和经济效益。

Ultrasound assessment of application of medical anti-adhesion membrane in prevention of incision adhesions after cesarean section

Objective To assess the clinical application value of medical anti-adhesion membrane in the prevention of incision adhesions after cesarean section using ultrasound. Methods 300 pregnant women voluntarily requiring cesarean section and having the indications of cesarean section admitted to Longhua People＇s Hospital from January 2011 to July 2012 were divided into three groups according to the stage of labor： non-labor cesarean group, first stage of labor cesarean group and second stage of labor cesarean group. All cesarean section surgeries were carried out in the lower uterine segment. Each group was randomly divided into the treatment sub-group and the control sub-group, with 50 pregnant women in each sub-group （a total of 150 pregnant women in each sub-group）. In the treatment group, the medical anti-adhesion membrane （chitosan membrane） was placed around the lower uterine segment incision and the uterine surface opposite to the abdominal incision and the nearby intestinal surface. In the control group, no medical anti-adhesion membrane was used and the conventional abdominal closure was implemented. The postoperative incision adhesion rate and the healing of anterior ineison of lower lower uterine segment were compared between the two groups. Results One case of postoperative incision adhesion was observed in the treatment group and 37 cases of post- operative incision adhesion in the control group, including 18 cases in the non-labor cesarean group, 7 cases in the first stage of labor cesarean group and 12 cases in the second stage of labor cesarean group. There existed statistically significant differences between the two groups （P 〈 0.05 or P 〈 0.01）. The total effective rate of lower uterine segment incision healing was 98.00%, which was significantly better than the 74.67% of the control group, with statistically significant difference （P 〈 0.05）. Conclusion Medical anti-adhesion membrane can effectively prevent the abdominal adhesion after cesarean section, costs little, cause no pain and can significantly improve the quality of life, which will generate enormous social and economic benefits after wide application.