不同术式剖宫产术后二次开腹手术时盆腹腔粘连情况比较

目的 探讨Stark式剖官产术后腹膜及膀胱腹膜反折愈合及粘连发生情况。方法 采用回顾性分析的方法,对剖宫产术后二次开腹手术患者腹膜及膀胱腹膜反折粘连发生情况进行观察。其中,Stark式剖官产术后二次开腹手术89例（A组）,下腹纵切口式剖宫产术后二次开腹手术212例（B组）．Pfannenstiel切口式剖宫产术后二次开腹手术52例（C组）。比较3组患者剖宫产术后腹壁切口愈合情况以及腹直肌、腹膜、大网膜、膀胱腹膜反折愈合及粘连发生情况。结果 （1）腹壁切口愈合良好,瘢痕纤细：A组86．5％（77／89）,B组29．3％（62／212）,C组75．0％（39／52）;（2）腹直肌粘连：A组25．8％（23／89）,B组53．8％（114／212）,C组13．5％（7／52）;（3）大网膜粘连：A组13．5％（12／89）,B组56．1％（119／212）,C组25．0％（13／52）;（4）腹膜粘连：A组15．7％（14／89）,B组46．2％（98／212）,C组11．5％（6／52）;（5）腹膜未愈合：仅C组有1例,A组与B组均为0;（6）膀胱腹膜反折粘连：A组15．7％（14／89）,B组55．2％（117／212）,C组13．5％（7／52）。腹壁切口愈合及腹直肌、大网膜、腹膜、膀胱腹膜反折粘连情况,A组明显优于B组,两组比较,差异有统计学意义（P〈0．05）;A组与C组比较,差异无统计学意义（P〉0．05）。结论 Stark式剖宫产在腹壁切口愈合,减少腹直肌、大网膜、腹膜、膀胱腹膜反折粘连方面明显优于下腹纵切口式剖宫产;虽然与Pfannenstiel切口式剖宫产相比,差异无显著性,但Stark式剖宫产具有诸多公认的优点,值得推广。

Clinical observation of Stark cesarean section as secondary abdominal surgery

Objective To analyze secondary abdominal surgery after Stark cesarean section. Methods A retrospective analysis of the secondary operation after cesarean section was performed. Group A was Stark cesarean section (n=89) , group B was the longitudinal incision cesarean section (n=212) , and group C was Pfannenstiel incision cesarean section(n=52). Stark cesarean section was compared with Pfannenstiel incision cesarean section and the longitudinal incision cesarean section in abdominal wall scar healing, adhesion of rectus muscles, peritoneum, omentum, and healing or adhesion of visceral peritoneum. Results The rate of good abdominal incision healing and slender scar was 86.5%(77/89) in group A, 29.3%(62/212) in group B , and 75.0% (39/52)in group C, respectively. The rate of adhesion of rectus muscles was 25.8% (23/89)in group A, 53.8%(114/212) in group B, and 13.5% (12/89)in group C, respectively. The rate of adhesion of omentum was 13.5% (12/89)in group A, 56.1%(119/212) in group B, and 25.0%(13/52) in group C, respectively. The rate of peritoneal adhesion was 15.7%(14/89) in group A, 46.2%(98/212) in group B, and 11.5%(6/52) in group C, respectively. Only one case in group C the peritoneum was not healed. The rate of adhesion of visceral peritoneum was 15.7% (14/89)in group A, 55.2%(117/212) in group B, and 13.5% (7/52)in group C, respectively. Abdominal wall scar healing, adhesion of rectus muscles, omentum, peritoneum, and visceral peritoneum in group A were all better than group B. The difference was statistically significant(P<0.05). There were no differences between group A and group C(P>0.05). Conclusions The study shows that the Stark cesarean section is better than the longitudinal incision cesarean section in healing of abdominal wall scar, adhesion of rectus muscles, omentum, peritoneum, and visceral peritoneum, but compared with Pfannenstiel incision cesarean section, there is no difference statistically. However, the advantages of the Stark cesarean section lie in short surgical time, few injury, little bleeding, quick recovery, and short hospital stay time, thus it should be further popularized.