再次剖宫产术74例临床分析

目的 探讨不同剖宫产术式的利弊。方法 采用回顾性分析的方法，对74例再次剖宫产病例进行分析，包括：①手术总时间及术中出血量；②腹腔粘连状况；③子宫切口愈合情况。对74例进行再分组，进行组间比较上述几项指标，具体分组依据如下：缝合或不缝合壁层腹膜，子宫下段横切口、宫体纵切口，腹壁横切口、纵切口。结果 ①腹壁纵切口手术时间比腹壁横切口短，术中出血及腹腔粘连无差异；②子宫下段横切口比子宫体纵切口手术时间短，术中出血少，腹腔粘连情况较轻；③缝合壁层腹膜及不缝合壁层腹膜腹腔粘连情况无差异。结论 ①下腹横切口手术时间比纵切口长，因此对有可能再次开腹病人，行下腹纵切口不失为一个明智的选择；②子宫下段横切口比纵切口手术时间短，出血少，子宫愈合良好，粘连轻，由此术中一定要尽量少用子宫体纵切口；③缝合及不缝合壁层腹膜无差异，但本文认为在剖宫产中用微桥线间断缝合子宫膀胱反射腹膜、壁层腹膜1-2针，会使效果更好，值得推广。

Clinical Analysis on Second Uterine-incision Delivery

Objective To discuss the advantages of varied operative methods of uterine-incision delivery(U-D).MethodsThe clinical materials of 74 cases of such patient were analyzed in total operation time,bleeding volume,abdominal adhesion and uterus incision healing.They were divided groups secondly based on suture and the incision of parietal peritoneum,uterus and abdominal wall.ResultsThere was shorter operation time in longitudinal abdominal incision than that of transverse without difference in bleeding and adhesion.There was shorter time and less bleeding and adhesion in low-transverse uterus incision than others.There was no difference between adhesion in parietal peritoneum suture.ConclusionThere might better to select the lower abdominal incision to shorten operative time in second operations.There might be more benefit to use the lower uterus transverse incision.The suture of parietal peritoneum of 1～2 might be effective.