关于剖宫产术几个问题的探讨

目的：对剖宫产术的发展予以简介；对剖宫产术的效用及其合理应用予以评价。方法：主要是文献复习，并结合个人的经验，介绍剖宫产术发展史、指征，术式与技术要求以及并发症的防治，最后作出合理应用的评价。结果：对剖宫产术的命名（古典式剖宫产术→腹膜内—腹膜外剖宫产术→腹膜外剖宫产术→子宫下段剖宫产术）；剖宫产术的指征（孕妇方面，胎儿方面，母、婴方面）；剖宫产术术式及技术要求（剖壁切口、子宫切口、胎儿娩出、胎盘娩出、附带手术）；并发症及其防治（手术指征、术中操作、术后观察与处理）均作出讨论。结论：剖宫产术对孕妇或胎儿的紧急情况造成出口，以便进一步采取治疗措施；剖宫产术率不宜硬性规定，对医院条件相同者，可以较其围产儿与孕、产妇的病率及死亡率，若剖宫产术者多于经阴分娩者，而两率反高，不难看出该医院产科工作质量之低下，反之，亦然。

Discussion on several problems of cesarean section.

Abstract Objectives:To introduce the development of cesarean section and to appraise the effects and rational application.Methods:By reviewing literatures and the author's experience,the development of cesarean section,indications,operative types and technical requirements,as well as the prevention of complications were introduced.Finally the rational application of cesarean section was suggested and evaluated.Results:The nomenclatures of cesarean section(classical cesarean section→intraperitoneal extraperitoneal cesarean scetion→extraperitoneal cesarean section→low uterine segmental cesarean scetion),indications(maternal,fetal and meternal fetal),operative types and technical requirements (abdominal wall incisions,uterine incisions,fetal delivery,placental delivery and incident operations) as well as the prevention of their complications(operative indications,operative procedures,postoperative observations and treatments)were discussed.Conclusions:Cesarean section is available for making an“outlet”in case with meternal fetal emergency in order for the further treatment.The cesarean section rate could not be laid down any rules in the different conditions.By comparing the parturient's morbidity and perinatal mortality in the same conditions of several hospitals,if the cesarean section rate is more than that of the vaginal delivery,it is not difficult to demonstrate the poor quality of obstetric work in that hospital.