会阴手术切口美容缝合术150例临床分析

目的 探讨会阴手术切口美容缝合术的安全性、可行性及临床价值。方法 对2003～2004年我科150例住院分娩产妇经阴道分娩行会阴侧切术，切口缝合采用美容缝合术。结果 应用美容缝合术150例，无一例切口感染或裂开，且手术野美观，术后不需拆线，大大缩短了住院时间。患者术后切口均无红肿、硬结，无排异现象发生，切口愈合的近期和远期效果均好。结论 会阴手术切口美容缝合术安全有效，切口愈合好，手术野美观，值得推广应用。     

会阴侧切切口的临床护理

会阴切开缝合术是产科常用手术，为防止会阴Ⅲ度裂伤，缩短第二产程，尽快娩出胎儿，降低新生儿窒息、死亡率，会阴切开的比率不断增加。会阴侧切切口的愈合与产程长短、局部皮下脂肪厚度、产妇体质、手术者的缝合技术等因素有关。但科学合理的护理措施也是促进切口愈合的重要因素。产妇会阴侧切术5天拆线，但切口感染、水肿、裂开时有发生。自2003年1月开始，我院采用对会阴侧切切口行微波照射，切口拆线缩短为3—4天，一期愈合率显著提高，感染率下降。现报告如下。     

会阴切口愈合不良的护理

目的:提高会阴切口愈合率,减轻产妇的痛苦,探讨预防和护理的对策。方法:对我院2005年2月～2D09年2月18例会阴切口愈合不良患者的临床资料进行回顾性分析,总结护理对策。结果:会阴切口愈合不良重在做好产前、产时、产后的预防感染,加强医护人员的无菌观念和缝合技术,做好术后的观察和护理使产妇尽快康复。     

改进会阴切开缝合技巧的介绍

我院产科自 1999年对会阴切开缝合技巧进行了改进 ,减轻了产妇的痛苦 ,缩短住院天数 ,降低了会阴切口的感染率 ,收到了满意的效果 ,现报道如下。一、临床资料与方法1.研究对象 :1998年 1月～ 1999年 12月在我院住院分娩行阴道侧切的产妇 2 384例 ,其中 142 0例为观察组 96 4例产妇为对照组 ,两组产妇年龄 2 2～ 35岁 ,孕周 37～ 42周。2 .材料 :采用高分子可吸收的快微乔缝合线 ,这种线通过水解作用使共聚物降解为乙二醇和乳酸 ,术后 7～ 10 d完全吸收脱落 ,不需拆线。3.缝合方法 :对照组的产妇采用肠线缝合粘膜、肌层 ,丝线缝合皮下脂肪及…     

产道血肿69例的临床分析

目的通过对产道血肿的临床分析，指导临床正确掌握会阴裂伤及会阴切口缝合术。方法对我院近几年来69例产道血肿进行回顾性分析。结果阴道后壁及会阴切口顶端易发生血肿。结论熟悉盆底解剖及血管分布和走向，寻找出血点，给予缝扎，才能彻底止血，减少产道血肿的发生。     

改良式会阴侧切缝合术的优点

会阴侧切缝合术是产科最常见的一种小手术。会阴侧切术是使胎儿娩出顺利,防止裂伤,缩短第二产程,避免产后盆底松弛的有效手段。近年来提倡尽量减少会阴侧切,但产妇有妊娠合并症者、估计为巨大儿、第二产程有胎儿宫内窘迫、需要上吸引器或产钳等情况时都需要会阴侧切。改良式会阴侧切缝合术减少了会阴部的伤口感染、无需拆线、减少了产妇的住院天数、减少了费用。     

可吸收性线缝合会阴切口的临床观察

我院近1年来对会阴侧切伤口采用可吸收性线缝合，临床效果令人非常满意，现报告如下。     

预防性应用抗生素对会阴侧切的临床影响

在正常分娩过程中，为减轻胎头对盆底组织的压迫，缩短第二产程、加速分娩、避免会阴盆底组织裂伤，常常采用会阴侧切缝合术。目前对分娩的干预呈上升趋势，会阴侧切率也逐渐上升，相应的并发症也有所增加，术后切口感染作为最常见的并发症，临床上存在对其全身应用抗生素预防性治疗的现象。本文就此治疗方法进行了分析，探讨其效果，为临床控制术后切口感染提供一定的理论依据，更好地指导围术期用药和切口感染的预防。     

会阴侧方切口感染的防治

会阴侧方切开术(会阴侧切术)是产科一种非常普遍的手术,在很大程度上可以使母婴免受产时损伤,但也存在相应的并发症,其中之一就是切口感染。会阴侧方切口感染的原因众多,主要包括产妇自身因素和医源性因素。做好会阴侧切感染的预防,以及一旦发生侧切感染如何做到早发现、早诊断、早治疗是文章阐述的重点。     

使用2-0可吸收线会阴切口皮下美容缝合与传统丝线缝合对产妇康复的影响

目的分析使用2-0可吸收线会阴切口皮下美容缝合术对产妇产后康复的影响。方法选择2012年1月~2014年1月到我院进行分娩且会阴切开的产妇620例作为研究对象,随机将其分成观察组和对照组,各310例。观察组患者行2-0可吸收线会阴切口皮下美容缝合术,对照组患者行传统丝线会阴切口缝合术,比较两组切口愈合效果、住院时间等情况。结果观察组切口甲级愈合率高达99.68%,对照组切口甲级愈合率仅为86.13%,差异有统计学意义(P0.05);术后住院时间相比,研究组显著少于对照组,差异有统计学意义(P0.05)。结论皮下美容缝合术可明显减轻产后切口疼痛,活动受限性,利于产妇休息和母乳喂养,提高产后生活质量。并且患者术后切口愈合好、住院时间短,疗效显著,值得推广应用。     

再次剖宫产时对原子宫切口愈合情况相关因素分析

目的:分析再次剖宫产时,原子宫切口愈合情况,探讨影响其愈合的相关因素。方法:本文对78例再次剖宫产者,术中所见及前次手术资料进行临床分析。结果:子宫切口愈合不良的发生率为28.2%,与术后间隔时间、术后感染率、子宫切口位置高低、腹腔粘连程度有关,而与剖宫产时机、孕妇的年龄、职业、孕产史、体重、孕周、胎儿的大小无关。结论:剖宫产后再次妊娠的时间至少应距前次妊娠间隔3年,前次剖宫产有术后病率及子宫切口情况不祥者,再次足月妊娠最好不选择阴道试产,以防子宫破裂发生,确保母婴安全。     

Surgery results using different uterine wall incision directions in laparoscopic myomectomy of the intramural myoma

Objective :  To study clinical outcomes for different uterine wall incision directions, comparing vertical incision and transverse incision in laparoscopic myomectomy of the intramural myoma.
Methods :  Laparoscopic myomectomies were performed on 50 women with intramural myomas. Using a table of random numbers, they were randomly divided into a vertical incision group (25 women) and a transverse incision group (25 women) according to the direction of incisions in the uterine wall. The numbers of enucleated myoma, operation duration, amount of bleeding, and numbers of sutures were compared. The Mann–Whitney U -test was used for analysis.
Results :  For the transverse incision group, the amount of bleeding (137.6 ± 88.1 mL) was a significantly lower value ( P  = 0.0426) than for the vertical incision group (235.8 ± 169.4 mL). In addition, in cases where the maximum myoma nucleus diameter was 7 cm or larger, operation duration (129.0 ± 32.5 min) and amount of bleeding (158.9 ± 87.1 mL) showed significantly lower values ( P  = 0.0067 and P =  0.0002, respectively) for the transverse incision group than did operation duration (362.3 ± 147.3 min) and amount of bleeding (362.3 ± 147.3 mL) for the vertical incision group.
Conclusion :  Transverse incision of the uterine wall is useful to reduce the amount of bleeding in the laparoscopic myomectomy of the intramural myoma. Transverse incision also shortens operation duration in cases where the myoma nuclei are large. (Reprod Med Biol 2004; 3 : 33–37)     

小开腹改良子宫切除术的探讨

目的探讨小开腹改良子宫切除术的优越性。方法对73例患子宫良性病变行小开腹改良子宫切除术,同期随机选择73例类似病人采用传统子宫切除术作为对照。结果比较两组在手术时间、出血量以及术后恢复方面有显著差异。结论,小开腹改良子宫切除术操作简单,切口小而美观,出血少,手术时间短,病人康复快,较传统式子宫切除术有一定的优越性。     

Use of the PROACT System for reduction of postsurgical peritoneal adhesions

OBJECTIVE: To assess the efficacy and safety of a new surgical device designed to prevent adhesions. DESIGN: Prospective, controlled two-phase porcine study. SETTING: Good Laboratory Practice-certified animal facility. ANIMAL(S): Phase I: 10 pigs underwent peritoneal treatment with the PROACT System (NTERO Surgical, Inc., Palo Alto, California) at the time of the laparotomy incision, and four had the incision made without treatment. Phase II: 22 animals were randomized to treatment or control groups. INTERVENTION(S): Animals in both groups underwent laparotomy incision and small bowel resection. The treatment group received treatment to the peritoneum before the peritoneal incision was made. Necropsy and adhesion evaluation were conducted by a blinded reviewer 7-13 days after the initial surgery. MAIN OUTCOME MEASURE(S): Presence or absence of adhesions. RESULT(S): Phase I: no treated animal developed adhesions to the incision site; three of four control animals developed adhesions to the incision site. Phase II: 4 of 10 control animals and no treated animals developed midline abdominal wall adhesions. Distal adhesions tended to also be reduced in treated animals. No side effects or increased risks were noted. CONCLUSION(S): The PROACT System appears to be safe and efficacious in reducing adhesions to the laparotomy incision line in the porcine model.     

Choice of abdominal incision and risk of trauma to the urinary bladder and bowel in multiple cesarean sections

OBJECTIVE: To determine if the midline subumbilical incision reduces the risk of trauma to bladder and bowel in women undergoing multiple cesarean sections. STUDY DESIGN: Retrospective analysis of hospital histories of 3164 women who had repeat cesarean sections at a referral maternity hospital. METHODS: The clinical records of women who had between one and eight cesarean sections over a 4-year period to October 2002 were examined for entries on injury to bladder and bowel. The frequency of these injuries in relation to abdominal incision used was determined. Multiple logistic regression analysis was performed to assess the influence of cesarean number, abdominal incision, intraperitoneal adhesions, operator experience, and anterior placenta previa on risk of bladder injury. MAIN OUTCOME MEASURE: Frequency of trauma to bladder and bowel associated with either Pfannenstiel or midline incision. RESULTS: There were 3164 women who met the inclusion criteria to the study. The midline incision was associated with significantly higher risk than Pfannenstiel for injury to the bladder (P<0.0001, OR 6.7, 95% CI 2.6-16.5). For both incisions, injury to the bladder increased with rising cesarean number. In addition, for a given cesarean other than primary, bladder trauma was more likely with the midline incision. The risk of injury to bowel was higher with the midline incision (RR 5.5), but there were too few events to permit Chi square analysis. CONCLUSION: In repeat cesarean section, the midline incision is associated with a higher risk of bladder and bowel injury than Pfannenstiel.     

Fresh autologous transplantation of ovarian cortical strips to the anterior abdominal wall at the pfannenstiel incision site

OBJECTIVE: To describe an open surgical technique for transplanting fresh ovarion tissue to the anterior abdominal wall at the incision site and to determine whether ovarian function would be restored after transplantation. DESIGN: Case study. SETTING: Academic medical center. PATIENT(S): A 44-year-old patient who underwent an operation for uterine fibroids. INTERVENTION(S): Microsurgical reconstruction of ovarian cortex and its transplantation to the anterior abdominal wall at incision site of Pfannenstiel. MAIN OUTCOME MEASURE(S): Follicular development evident by ultrasound examination; restoration of serum FSH and LH levels to nonmenopausal range; and disappearance of menopausal symptoms. RESULT(S): Early postoperative FSH, LH, and E(2) levels showed that menopause was confirmed. Postoperative hormone levels at months 2, 3, and 6 were as follows: FSH: 77.86, 79.50, and 13.70 mIU/mL; LH: 34.60, 33.92, and 8.78 mIU/mL; E(2): 29, 46, and 48 pg/mL. The patient is still followed-up for postmenopausal status. CONCLUSION(S): Autotransplantation of cortical strips to the anterior abdominal wall at the incision site without further incision can be a logical solution for the patients at early climacteric age.     

新式剖宫产术后子宫复旧及子宫切口愈合情况的B超监测

目的观察新式剖宫产子宫复旧和子宫切口愈合情况。方法两组各150例,观察组行新式剖宫产术,对照组行传统子宫下段剖宫产术。于术后7天、30天分别行盆腔B超检查观察子宫复旧及子宫切口愈合情况。结果两组病例术后7天、30天子宫各径线大小无显著差异(P＞0.05);对照组术后30天宫腔积液发生率显著高于观察组(P＜0.05);观察组术后30天子宫切口回声区域的纵径显著小于对照组(P＜0.05);观察组术后30天子宫切口A型愈合率显著高于对照组(P＜0.05)。结论新式剖宫产术因子宫切口局部缝线少、异物反应小、吸收快,是有利于子宫复旧和子宫切口愈合的手术方式。     

Transverse fundal uterine incision for delivery of extremely low birth-weight infants

Abstract

Caesarean section of extremely low birth-weight (ELBW) infants is sometimes challenging for obstetricians. To date, there have been no standard types of uterine incision to achieve an atraumatic birth for ELBW fetuses with the placenta covering the whole anterior uterine wall. We present seven cases of transverse fundal uterine incision to avoid incision into the placenta. All the seven cases had successful en caul deliveries (the mean birth weight, 619?±?213?g), accompanied by good neonatal conditions. Transverse fundal uterine incision may be a safe and feasible caesarean technique in ELBW infants when incision into the placenta is otherwise unavoidable.     

Richter’s hernia occurring through a 5-mm laparoscopy sheath incision

We report a case of postoperative Richter’s hernia presenting through a 5-mm sheath incision. A 58-year-old woman having undergone laparoscopic hysterectomy 8 days before presented with severe left abdominal pain, nausea and light-headedness. The hypothesis of a sigmoid volvulus was suggested based on peroperative rectum and sigmoid release, the X-ray finding, and pain evolution. A secondary laparoscopic procedure allowed both diagnosis of a Richter’s hernia through a 5-mm sheath incision and surgical repair of the hernia. The use of this sheath during the laparoscopic vagina suture caused extension of the wound. Large 5-mm sheath defect sufficient for a Richter’s hernia can be created by multiple passes with small instruments and require surgical closure at the end of laparoscopy. Laparoscopy is useful in cases of postoperative complications, particularly when other complementary examinations are less informative.     

子宫单切口与双切口术式在凶险性前置胎盘的应用

目的:比较子宫单切口与子宫双切口在凶险性前置胎盘患者手术中的临床应用价值。方法:收集2016年12月至2018年12月于甘肃省妇幼保健院住院剖宫产手术分娩,根据术前超声检查评分诊断并在术中确诊为凶险性前置胎盘的孕妇共136例,根据术前、术中的评估,采用子宫下段单切口术式的94例(69.1%)为子宫单切口组、采用子宫双切口术式的42例(30.9%)为子宫双切口组。收集两组孕妇的年龄、孕次、剖宫产次数、术中出血量、术中输血量及手术时间、术后并发症及围产儿结局等资料,并进行比较分析。结果:子宫双切口组与子宫单切口组在前置胎盘严重程度、孕妇的年龄、孕次、流产次数、既往剖宫产次数、终止妊娠的孕周方面比较,差异均无统计学意义(P>0.05)。子宫单切口组与子宫双切口组孕妇的术中出血量分别为2852.74±1060.26 ml、1578.26±916.53 ml、输红细胞量分别为1549.56±986.36 ml、1052.35±589.69 ml、手术时间分别为125.30±36.63分钟、148.42±40.75分钟,差异均有统计学意义(P<0.05)。子宫切除子宫单切口组12例,双切口组3例,差异无统计学意义(χ~2=0.935,P=0.334)。子宫单切口组与子宫双切口组在术后凝血功能异常的发生、住院时及术后发热方面比较,差异均有统计学意义(P<0.05)。两组孕妇在膀胱损伤的发生、术后24小时出血、新生儿Agpar评分方面比较,差异无统计学意义(P>0.05)。结论:子宫双切口应用于凶险性前置胎盘剖宫产手术中,能够减少术中出血、保留子宫及降低术后凝血功能异常的发生。