首次剖宫产术式对高龄孕妇再次剖宫产手术的影响分析

目的：分析首次剖宫产术式对高龄孕妇再次剖宫产手术的影响,指导远期安全性更佳的首次剖宫产术式的选择.方法：选取我院2010年9月至2013年9月收治的再次行剖宫产高龄产妇277例,按照其首次剖宫产术式分为传统腹壁纵切口A组（n=151）及新式腹壁横切口B组（n =126）,比较两组孕妇再次剖宫产的妊娠结局.结果：A组手术时间、术中出血量、肛门排气时间及住院时间均低于B组,两组数据比较存在统计学差异（P＜0.05）;A组孕妇共发生78例腹腔粘连,发生率51.7％,B组发生100例,发生率79.4％,A组腹腔粘连发生率显著低于B组（P＜0.05）,且其粘连分度亦显著低于后者;A组产后出血5例,发生率3.3％,B组产后出血9例,发生率7.1％,两组新生儿均未发生窒息,两组孕妇产后出血发生率无明显统计学差异（P＞0.05）.结论：首次剖宫产术式的选择可影响孕妇再次剖宫产并发症的发生率,新式剖宫产术对有再次剖宫产意愿的孕妇风险更高,可导致其手术时间增加、出血量上升、并发症风险增高,而传统剖宫产术可有效规避上述风险.

Effect of primary caesarean section on re-caesarean operation of advanced pregnant women

Objectives： To analyze the effect of primary cesarean section on re - cesarean operation of ad- vanced pregnant women, guiding the choice of primary cesarean section with better and long - term safety. Methods： 277 advanced pregnant women admitted to our hospital from September 2012 - September 2013 for re - cesarean operation were divided into group A （n = 151 ） and group B （n = 126） according to the primary cesarean section, i.e. those adopted the traditional abdominal vertical incision and new transverse abdominal incision were group A and B respectively. The pregnancy outcome of the two groups was compared after re -cesarean operation. Results： The operation time, intraoperative blood loss anal exhaust time and hospital stays of group A were lower than those of group B, with statistically significant difference （ P 〈 0.05 ） ; the incidence rate of peritoneal adhesion was 51.7% （78/151） and 79.4% （100/126） respectively, with significantly difference （ P 〈 0.05） ; 5 patients in group A （3.3%） and 9 patients in group B （7.1%） experienced postpartum hemorrhage, with no statistically sig- nificant difference （P 〉 0.05） ; no neonatal asphyxia occurred in the two groups. Conclusion： The primary cesare- an section may affect the incidence rate of complications after re - cesarean operation. Compared with traditional cesarean section, new cesarean section is of higher risks for re - cesarean operation, with increased operation time, intraoperative blood loss and risk of complications.