半腹膜外剖宫产术临床分析

目的探讨优化腹膜外剖宫产术式和减少手术并发症的方法。方法100例有剖宫产手术指征的孕妇随机分为两组:半腹膜外组50例,腹膜外组50例。半腹膜外组采用半腹膜外剖宫产术式,腹膜外组采用腹膜外剖宫产术式。结果半腹膜外组胎儿娩出困难需产钳助产率为4%,腹膜外组为30%,两组比较差异有统计学意义(P<0.01);半腹膜外组一过性血尿发生率为4%,腹膜外组为26%,两组比较差异有统计学意义(P<0.05);半腹膜外组和腹膜外组在手术时间、术中出血量、术后病率、排气时间、新生儿1minApgar评分5～7分、新生儿平均体质量方面差异无统计学意义。结论半腹膜外剖宫产术同样具有腹膜外剖宫产术的不干扰腹腔脏器,术后反应轻、并发症少的优点,还有手术方法简单、胎儿娩出迅速、膀胱损伤小、能探查附件的优点。     

半腹膜外子宫切除35例分析

我院1998-11～1999-11共施行半腹膜外子宫切除术35例,效果满意,现报道如下.     

腹膜外剖宫产512例临床分析

512例胸膜外剖宫产与同期施行的其它术式剖宫产比较，腹膜外剖宫产可使腹腔脏器免受手术干扰及污染，具有手术时间短、肠功能恢复快及手术后病率低等优点。其手术关键是分离膀胱筋膜和子宫膀胱腹膜反折，术后一般不需安置引流管，导尿管亦可于麻醉作用消失后尽早拔除，并发症极少，值得产科临床推广使用。     

筋膜内游离膀胱法腹膜外剖宫产152例临床分析

由于腹膜外剖宫产操作及麻醉技术水平均提高，近年其适应证范围逐步扩大，采用此术式越来越多．本文152例剖宫产采用筋膜内游离膀优法与单纯侧入法游离膀阶66例作对比分析，报道如下。1临床资料①选择1996－06－1997－12住院病人行筋膜内游离膜优法腹膜外剖宫产152例为观察组，1995．06－1996－06行单纯侧入法游离膀眈股股外剖宫产66例为对照组，两组在干术指证、孕妇年龄、孕周、孕产次、胎儿大小等方面差异无品著性，两组80％采用连续硬膜外麻醉．①手术办法，术前均留置尿管，排宁腹胀，腹部切口均选择下股纵切口．观察组分离股直肌后推…     

腹膜外与腹膜内剖宫产的效果比较

现将我院腹膜外剖宫产200例进行总结,并与腹膜内剖宫产进行比较,现报道如下。1 资料 我院1999年1月～2000年9月行腹膜外剖宫产200例,并与同期腹膜内剖宫产200例比较,手术者均应用连续硬膜外麻醉,其手术指征比较见表1。     

半腹膜外子宫切除术86例临床分析

我院自1995年以来施行半腹膜外子宫切除术86例,取得了良好效果,无副损伤及并发症,现报道如下．l临床资料l'l一册资料本组86例中,子宫肌瘤33例,妊娠合并子宫肌瘤22例,子宫腺肌症8例,功血12例,子宫肌瘤并卵巢囊肿10例,子宫绒癌1例．！．2手术方法常规术前准备,行硬膜外麻醉,留置尿管开放,取平卧位,臀略高于上身,便于盆腔暴露．除外有手术史者仍取纵行切口,一般均取下腹部横切口．取耻骨联合上二指处做模弧形切口thsc以视子宫大小而定切口长度）,切开皮肤及皮下组织,横弧形（孤口向上）剪开腹直肌前鞘及二侧腹外斜肌腹膜,提…     

改良的半腹膜外子宫全切术138例临床分析

1995－10～1998-08，我们两院对有子宫全切手术指征的患者施行了改良式半腹膜外子宫全切术，计138例，效果良好，报道如下．1资料与方法1．1病例选择本组病例为采用改良的半腹膜外子宫全切术138例，年龄32wt8岁，平均40岁，其中子宫肌瘤98例，功血26例，子宫内股异位症14例，均伴有不同程度的宫颈糜烂及肥大．12术前准备术前宫颈碘试验或刮片排除宫颈癌，术前3d冲洗阴道，入手术室前碘酒、酒精或新活水灭清洁阴道，干棉球擦干，徐龙胆紫，留置导尿管．l．3手术方法连续硬膜外麻醉下平卧位，术区常规消毒，辅无菌巾，取下腹Pfhllllcn幻iel横…     

腹膜外剖宫产术128例的临床体会

目的探讨腹膜外子宫下段剖宫产术的优越性。方法对128例行腹膜外子宫下段剖宫产术者（观察组）和128例行腹膜内子宫下段剖宫产术者（对照组）的临床资料进行回顾性分析。结果两组术中出血量、从切皮到取出胎儿的时间、总手术时间、新生儿评分情况差异均无显著性（P〉0．05）,术后肛门排气时间、下床活动时间、抗生素应用时间、住院时间、术后病率、切口甲级愈合情况两组差异有显著性（P〈0．05）。结论腹膜外子宫下段剖宫产术未进行腹腔内操作,避免了腹腔黏连、肠梗阻,并发症少,术后胃肠恢复快,操作简单,对于再次剖宫产患者优越性更大,值得临床推广应用。     

86例胎膜早破合并早产临床分析

目的：观察胎膜早破合并早产的相关因素及对母婴的影响。方法：对86例胎膜早破合并早产进行回顾性分析。结果：55．8％的胎膜早破合并早产存在危险因素。孕28—34周与34^＋1-37周比较，而孕28-34周的新生儿死亡率和不良预后事件明显高于34^＋1-37周者。结论：对于不同孕周胎膜早破合并早产患者需采取不同应对方法以减少新生儿并发症。     

足月胎膜早破先露衔接对剖宫产指征的影响

Objective To explore the cesarean section indications of fetal presentation unengagement in primipara with full-term premature rupture of membrane. Methods Five hundreds and ten primipara with premature rupture of membrane at term were divided into 2 groups: the fetal head was not engaged in the birthing process ( study group 218 cases) and engaged in the birthing process( control group 292 cases). The delivery course and the incidence of complication of the mother and infant were compared between 2 groups. The main outcome measure was the rate of caesarean section, indications of cesarean section, the cervical maturity(by Bishop scoring), the rate of fetal distress and newborn asphyxia, et al. Results The rate of cesarean section was higher in study group (64.7%) than that in control group( 17.5% ) ( P ＜0.01 ), so were the rate of fetal distress, stagnant labor and of failure of induction( P ＜0.05 ). In the cases of study group, the cervical condition of easy delivery ones was better than that of caesarean section ones. Average neonatal weight of easy delivery ones is lighter than caesarean section ones. Conclusions When the fetal head is not engaged in the birthing process in primipara with premature rupture of membrane at term, the labor induction is difficult. The labor complications are common, and the rate of caesarean section is high because of the loss of amniotic fluid and the poor cervical condition. Primipara at term whose presentation is not engaged in the birthing process should try to avoid premature rupture of membrane. Cervical ripening and induction should be done as soon as possible after membrane rupture.     

足月胎膜早破先露衔接对剖宫产指征的影响

Objective To explore the cesarean section indications of fetal presentation unengagement in primipara with full-term premature rupture of membrane. Methods Five hundreds and ten primipara with premature rupture of membrane at term were divided into 2 groups: the fetal head was not engaged in the birthing process ( study group 218 cases) and engaged in the birthing process( control group 292 cases). The delivery course and the incidence of complication of the mother and infant were compared between 2 groups. The main outcome measure was the rate of caesarean section, indications of cesarean section, the cervical maturity(by Bishop scoring), the rate of fetal distress and newborn asphyxia, et al. Results The rate of cesarean section was higher in study group (64.7%) than that in control group( 17.5% ) ( P ＜0.01 ), so were the rate of fetal distress, stagnant labor and of failure of induction( P ＜0.05 ). In the cases of study group, the cervical condition of easy delivery ones was better than that of caesarean section ones. Average neonatal weight of easy delivery ones is lighter than caesarean section ones. Conclusions When the fetal head is not engaged in the birthing process in primipara with premature rupture of membrane at term, the labor induction is difficult. The labor complications are common, and the rate of caesarean section is high because of the loss of amniotic fluid and the poor cervical condition. Primipara at term whose presentation is not engaged in the birthing process should try to avoid premature rupture of membrane. Cervical ripening and induction should be done as soon as possible after membrane rupture.     

足月胎膜早破先露衔接对剖宫产指征的影响

目的 探讨胎膜早破患者的胎先露衔接情况对剖宫产指征的影响.方法 选择我院2008年4月至2009年4月足月妊娠(孕37～41+6周)分娩的510例胎膜早破初产妇.根据先露衔接与否分为未衔接组(218例)和衔接组(292例).对2组分娩方式、剖宫产指征、宫颈Bishop评分、新生儿结局进行分析.结果 不衔接组剖宫产率为64.7%(141/218),衔接组剖宫产率为17.5%(51/292),2组比较差异有统计学意义(P＜0.01).不衔接组的胎儿窘迫、胎方位异常、活跃期停滞、引产失败率均高于衔接组(18.9%比8.9%,12.8%比3.4%,12.4%比1.0%,15.6%比2.4%,P＜0.05).不衔接组顺产孕妇的宫颈Bishop评分高于剖宫产孕妇的宫颈Bishop评分[(4.2±1.3)分比(3.5±1.7)分,P＜0.01],顺产孕妇新生儿平均体重低于剖宫产孕妇的新生儿平均体重[(3.1±0.3)kg比(3.3±0.5)kg,P＜0.05].结论 胎膜早破胎先露不衔接者由于破膜后羊水流失难以控制、宫颈条件差,导致引产难度大、分娩并发症多、剖宫产率高,故足月后先露部尚未衔接者应尽可能避免胎膜早破,胎膜早破后应尽快促宫颈成熟、终止妊娠.

Abstract：

Objective To explore the cesarean section indications of fetal presentation unengagement in primipara with full-term premature rupture of membrane. Methods Five hundreds and ten primipara with premature rupture of membrane at term were divided into 2 groups: the fetal head was not engaged in the birthing process ( study group 218 cases) and engaged in the birthing process( control group 292 cases). The delivery course and the incidence of complication of the mother and infant were compared between 2 groups. The main outcome measure was the rate of caesarean section, indications of cesarean section, the cervical maturity(by Bishop scoring), the rate of fetal distress and newborn asphyxia, et al. Results The rate of cesarean section was higher in study group (64.7%) than that in control group( 17.5% ) ( P ＜0.01 ), so were the rate of fetal distress, stagnant labor and of failure of induction( P ＜0.05 ). In the cases of study group, the cervical condition of easy delivery ones was better than that of caesarean section ones. Average neonatal weight of easy delivery ones is lighter than caesarean section ones. Conclusions When the fetal head is not engaged in the birthing process in primipara with premature rupture of membrane at term, the labor induction is difficult. The labor complications are common, and the rate of caesarean section is high because of the loss of amniotic fluid and the poor cervical condition. Primipara at term whose presentation is not engaged in the birthing process should try to avoid premature rupture of membrane. Cervical ripening and induction should be done as soon as possible after membrane rupture.     

早产胎膜早破的临床治疗

目的:探讨早产胎膜早破的临床治疗。方法:对232例早产胎膜早破的孕妇资料进行回顾性分析。结果:<34周孕组围生儿死亡率及呼吸窘迫综合征(RDS)发生率(20.8%和15.6%)明显高于≥34周孕组(1.9%和1.3%);而在<34周孕组中,保胎≥48小时后出现的新生儿死亡率及RDS发生率(8.8%和7.0%)较保胎<48小时者(38.5%和28.2%)明显下降。结论:早产胎膜早破期待治疗应当因人施治,对于孕周小者,应尽量延长妊娠至孕34周以上,以降低新生儿的死亡率。     

早产并胎膜早破86例临床分析

目的探讨早产胎膜早破的妊娠结局。方法对86例早产胎膜早破进行回顾性分析。比较不同孕周对围生儿结局的影响。结果主要诱因为胎位异常及双胎等因素造成宫腔内压力改变。孕28~34周早产胎膜早破新生儿窒息率和死亡比明显高于孕34~37周。结论对于孕28~34周早产胎膜早破患者,宜采取期待疗法,以减少新生儿并发症的发生。预防性应用抗生素,选择合适分娩时机及方式,能获得良好妊娠结局。     

胎膜早破妊娠结局的分析

目的：探讨胎膜早破对妊娠结局的影响。方法：对160例胎膜早破住院分娩孕妇和905例无妊娠并发症正常分娩孕妇作回顾性分析。结果：胎膜早破组的剖宫产率、早产率、新生儿窒息率及肺炎发病率均比对照组显著升高。结论：胎膜早破是难产的常见并发症之一，对母婴造成不良影响。     

胎膜早破225例临床分析

目的：探讨胎膜早破的危险因素以及对母婴的影响。方法：选取本院2007年9月～2010年8月收治的225例胎膜早破产妇的临床资料,记为观察组,选取同期收治的200例无胎膜早破产妇的临床资料作为对照,记为对照组,比较两组母婴并发症以及难产发生率,分析胎膜早破的危险因素。结果：观察组产妇发生难产以及母婴并发症发生率明显高于对照组,两组患者比较差异有统计学意义（P〈0.05）。胎位不正、早产流产史、妊娠高血压是胎膜早破的危险因素。结论：胎膜早破是新生儿发病和死亡的主要原因,应重视胎膜早破的危险因素,做好正确的预防、诊断和治疗,减少母婴并发症。     

妊娠血清铜、阴道细菌与胎膜早破的关系初探

目的 探讨胎膜早破与血清铜的关系。方法 对８０例正常单胎分娩的孕妇,其中１７例确认 明显诱因的胎膜早破（ＰＲＯＭ）。分娩前阴取道上１／３外分泌物涂片镜检,测定血清铜的含量,分娩后取胎膜观察病理改变,同时测定门诊孕早期孕妇血清铜５０例。结果孕晚期妇女血清铜值明显高于孕早期,但胎膜早破组和正常组孕妇的血清铜差异无统计学意义。结论 胎膜早破与血清铜无明显关系。     

113例新生儿胎膜早破并发早产预后分析

目的探讨胎膜早破并发早产不同胎龄、孕28—34^＋6周不同潜伏期、不同分娩方式对新生儿的影响。方法对我院2003年1月至2005年6月胎膜早破并发早产113例新生儿并发症进行回顾性分析。结果28—34^＋6周新生儿窒息、新生儿肺透明膜病、及缺氧缺血性脑病高于35—36^＋6周（P〈0．05）；28—34^＋6周潜伏期〈72h新生儿窒息、新生儿缺氧缺血性脑病、新生儿死亡高于潜伏期〉72h组（P〈0．05）；臀牵引与其它分娩方式在出现新生儿并发症方面比较有统计学意义（P〈0．05）结论对于胎膜早破不足35周者均应使用单疗程激素治疗，以减少早产儿并发症、降低新生儿病死率。若为臀位，选择剖宫产对胎儿较为有利。