不同术式再次剖宫产腹壁愈合腹腔粘连情况比较分析

目的:分析3种剖宫产术式术后腹壁愈合及腹腔粘连的情况。方法:采用回顾性分析的方法,对剖宫产术后再次剖宫产时患者腹壁愈合腹腔粘连的情况进行观察。按第1次剖宫产术式不同分为3组:改良腹部横切口式剖宫产者为A组92例,Stark式腹部横切口剖宫产者为B组88例,下腹纵切口式剖宫产者为C组112例。比较3组患者腹壁愈合以及腹直肌、腹膜、膀胱腹膜反折粘连的情况。结果:A、B组腹壁愈合情况好,愈合佳的比率分别为76.09%(70/92)和77.27%(68/88),明显高于C组的25.89%(29/112),A、B组比较差异无统计学意义(P>0.05),与C组比较各级差异均有统计学意义(P<0.001);腹直肌粘连严重的比率A组为40.22%(37/92),C组为11.61%(13/112),明显低于B组的71.59%(63/88),3组比较差异均有统计学意义(P<0.001);腹膜粘连率A组为42.39%(39/92),C组为33.04%(37/112),与B组的61.36%(54/88)相比,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);3组膀胱腹膜反折的粘连率差异无统计学意义(P>0.05)。结论:剖宫产术后腹壁愈合、腹腔粘连情况与手术术式有关,改良腹部横切口式剖宫产者再次剖宫产时腹壁愈合佳,腹直肌、腹膜粘连少。为预防再次手术粘连的问题应慎重选择手术术式。

Clinical observation of three kinds of cesarean section as reoperation

Objective: To analyze the cicatrisation and adhesion of three kinds of cesarean section as reoperation. Methods: A retrospective analysis of the secondary operation after cesarean section was performed. Group A was the improvement of transverse incision cesarean section(n=92),Group B was Stark cesarean section(n=88),Group C was the longitudinal incision cesarean section(n=112). Abdominal wall scarhealing ,adhesion of rectus muscles, peritoneum and visceral peritoneum were observed. Results: The rates of abdominal incision healing were 76.09%(70/92) in group A , 77.27%(68/88) in group B and 25.89%(29/112) in group C. It was higher in group A and B than that in group C (P<0.001). But the adhesion of rectus muscles were 40.22%(37/92) in group A, 11.61%(13/112) in group C were lower than 71.59%(63/88) in group B. They showed significantly differences among three groups(P<0.001). The rates of peritoneal adhesion in group A 42.39%(39/92) and group C 33.04%(37/112) were lower than in group B 61.36%(54/88) (P<0.05). The adhesion of visceral peritoneum was no difference in three groups (P>0.05). Conclusion: The study shows that the cicatrisation and adhesion of three kinds cesarean section is related with the methods of operation. The improvement of transverse incision cesarean section is better in healing of abdominal wall scar, peritoneal adhesion and adhesion of rectus muscles. Therefore the selection of cesarean section is important to prevent the adhesion in secondary operation.