腹膜外剖宫产联合产钳在瘢痕子宫再次剖宫产术中的应用  

Clinical analysis of extraperitoneal cesarean section plus forceps in repeated cesarean section

作　　者：纪国欣[1,2] 董瑞峰[1] 张倩[1] 孟岚[1] 徐风森[1] 

机构地区：[1]青岛市市立医院产科,山东省青岛266011 [2]山东青岛大学医学院

出　　处：《中国基层医药》2015年第2期240-243,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的 观察腹膜外剖宫产联合产钳在瘢痕子宫孕妇再次剖宫产术中的临床应用价值.方法 对再次剖宫产产妇98例的临床资料进行回顾性分析,其中腹膜外剖宫产联合产钳产妇47例（A组）,腹膜内剖宫产产妇51例（B组）,比较两组临床效果.结果 A组从切皮至胎儿娩出时间、手术总时间分别为（7.7±2.8）min、（42.8±9.7） min,较B组的（9.3±3.2）min、（47.6±9.4） min显著缩短（=2.700、2.497,P=0.008、0.014）;两组术中及术后2h出血量分别为（310.4±106.3）mL、（365.3±142.8）mL,两组差异有统计学意义（t=2.142,P=0.035）;术后疼痛VAS评分A组（2.8±1.8）分,显著少于B组的（4.1±1.9）分（t=3.252,P=0.002）;术后胃肠功能恢复时间A组（12.5±5.9）h,显著短于B组的（16.0±6.6）h（t =2.771,P=0.007）;术后发热率A组（8.5％,4/47）显著低于B组（25.5％,13/51）（χ^2=4.918,P=0.033）;术后随访慢性盆腔痛A组3例,B组12例,两组差异有统计学意义（χ^2=5.143,P=0.026）.新生儿1min Apgar评分、新生儿窒息发生率两组差异无统计学意义.结论 腹膜外剖宫产联合产钳较腹膜内再次剖宫产具有手术时间短、出血量少、术后病率低、并发症少等优点,且最大程度地克服了胎头娩出困难,不增加新生儿病率,手术适应证可等同于腹膜内剖宫产.Objective To observe the clinical application of extraperitoneal cesarean section（ECS） plus forceps vs transperitoneal cesarean sections（TCS） in repeated cesarean section.Methods 98 multiparous women with scar uterus for elective repeated cesarean sections were recruited retrospectively,47 cases for ECS plus forceps（group A）,and 51 cases for TCS（group B）.The multiparous women with hyperglycemia not controlled,severe preeclampsia,heart disease,placenta previa,premature rupture of membrane,a history of 〉 1 cesarean section,myoma and/or ovarian neoplasm were excluded.Results Skin incision to baby delivery time and total operation time of group A were （7.7 ± 2.8） min and （42.8 ± 9.7） min,respectively,which were significantly shorter than （9.3 ± 3.2） min and （47.6 ± 9.4） min of group B,（t =2.700,2.497,P =0.008,0.014）.There was significant difference in blood loss volume during the operation and postoperative 2 hours,which was （310.4 ± 106.3） mL,（365.3 ± 142.8） mL respectively（t =2.142,P =0.035）.The Visual Analog Scale for pain （VAS pain） was （2.8 ± 1.8） in group A and （4.1 ± 1.9） in group B,respectively （t =3.252,P =0.002）.The gastrointestinal function recovery mean time of group A was significantly shorter than that of group B （12.5 h versus 16.0h,t =2.771,P =0.007）.And the postoperative febrile morbidity was significantly lower in group A than in group B（8.5% versus 25.5% ;χ^2=4.918,P =0.033）.The patients with chronic pelvic pain followed up after operation was 3 versus 12,and the difference was significant （χ^2=5.143,P =0.026）.There were no differences in neonatal Apgar score at 1 minute,birth asphyxia and wound healing rates.Conclusion ECS plus forceps can be safely used for repeated cesarean section,with the advantages of less operation time,less bleeding volume,lower postoperative morbidity,and fewer complications than TCS.

关 键 词：剖宫产术 产钳 剖宫产术 再 

分 类 号：R719.8[医药卫生—妇产科学]