传统剖宫产与新式剖宫产术后再次剖宫产289例临床分析

目的分析不同剖宫产手术方式对再次剖宫产的影响，了解瘢痕子宫再次剖宫产手术的风险．以提高手术的安全性。方法回顾性分析289例再次剖宫产患者。其中对照组157例，前次手术为传统的腹部纵切口子宫下段剖宫产术，研究组132例，前次手术为新式剖宫产术。比较两组患者一般情况，包括：前次剖宫产间隔时间、年龄、孕周、新生儿体重等方面；术中情况，包括：开腹时间、总手术时间、术中出血量、粘连状况；术后情况，包括：术后排气时间、产褥病率、切口感染、产后出血。结果两组间一般情况各项比较。差异均无统计学意义。术中情况比较，研究组手术开腹时间、总手术时间、无粘连例数和重度粘连例数均明显低于对照组．前者分别为（8．33±2．65）min、（43．79±3．65）min、57例、15例，后者分别为（11．25±4．03）rain、（51．95±4．55）min、47例、48例，差异有统计学意义（P〈0．05）。术后情况比较，术后排气时间差异有统计学意义（P〈0．01）。结论新式剖宫产再次手术因粘连发生率低、手术时间短、术后恢复快，有利于降低再次剖宫产的手术难度和并发症的发生，值得在临床加以推广。

Clinical Analysis of 289 Cases of Repeat Cesarean Section with Tradition Cesarean Section and New-Style Cesarean Section

Objective To analyze different effects to the repeat cesarean section with different surgical methods and study the risks of repeat cesarean section for improving the safety of operation. Methods A retrospective analysis of 289 cases of repeat cesarean section were performed, in which the control group included 157 cases repeat cesarean section with tradition cesarean section and the investigate group included 132 cases repeat cesarean section with new-style cesarean section. It was observed in the two groups above that the interval between the repeat cesarean section and the first cesarean section, the age of patients, the gestational weeks, the weight of neonatus, the time of cutting abdominal, operative time, blood lose volume, the state of accretion, the time of aerofluxus, the rate of puerperal morbidity, the infection rate of postoperative and the rate of hemorrhage. Results There were no statistical significant differences between the two groups about age, the interval between the repeat cesarean section and the first cesarean section, the age of patients, the gestational weeks and the weight of neonatus. Compared with the control group, the investigate group had a significantly shorter time in cutting abdominal （P〈0.01） and operating （P〈0.05）, and the less rates of cases without accretio（P〈0.05） and with severity accretio（P〈0.01 ）. The time of aerofluxus in investigate group was shorter and the difference between the two groups was significant （P〈0.01）. Conclusion Application of new-style cesarean section in first cesarean section can improve security and reduce complications.