再次剖宫产手术粘连程度与首次剖宫产相关因素分析  

Relative factors analysis between the degree of adhesion in secondary cesarean section and the first cesarean section

作　　者：马吉红 张凌云 MA Jihong;ZHANG Lingyun(Jiaozhou Central Hospital,Qingdao,Shandong Province,266300)

机构地区：[1]青岛市胶州中心医院,266300

出　　处：《中国计划生育学杂志》2020年第7期1121-1124,1128,共5页Chinese Journal of Family Planning

基　　金：青岛市卫生科技计划项目(2018-WJZD084)。

摘　　要：目的:探讨再次剖宫产手术粘连程度与首次剖宫产可能相关影响因素。方法:回顾性收集2017年10月—2019年10月本院再次剖宫产产妇517例的临床资料,根据产妇再次剖宫产术中是否存在盆腹腔粘连分为无粘连组240例、轻度粘连组111例、中度粘连组126例、重度粘连组40例。进行单因素和多因素logistic分析、Spearman秩相关性分析,探讨首次剖宫产对再次剖宫产术中盆腹腔粘连程度可能影响因素。结果:首次剖宫产与再次剖宫产间隔≤2年、多胎妊娠、腹壁横切口、有羊水污染、有子宫切口撕裂、腹膜未缝合的产妇,再次妊娠发生不同程度盆腹腔粘连的比例增高(P<0.05)。两次剖宫产间隔时间与再次妊娠盆腹腔粘连程度呈负相关(r=-0.339,P<0.001),羊水污染程度与盆腹腔粘连程度呈正相关(r=0.487,P<0.001)。首次剖宫产发生羊水污染(β=1.139,OR=3.124,95%CI 1.715~5.690)、子宫切口撕裂(β=0.853,OR=2.347,95%CI 1.189~4.633)、腹膜未缝合(β=0.373,OR=1.459,95%CI 1.151~1.850)是再次剖宫产术中盆腹腔粘连的危险因素。结论:剖宫产手术宜选择腹壁纵切口、腹膜缝合,尽量避免羊水污染、子宫切口撕裂,有利于减少术后盆腹腔粘连。Objective:To investigate the r elative factors between the degree of adhesion in secondary cesarean section and the first cesarean section.Methods:The clinical data of 517 women undergone secondary cesarean section between October 2017 and October 2019 were analyzed retrospectively.According to the situation of pelvic and abdominal adhesions found during the secondary cesarean section,these women were divided into 240 women in group A(240 women without adhesion),group B(111 women with mild adhesion),group C(126 women with moderate adhesion),and group D(40 women with severe adhesion).Univariate analysis,multivariate Logistic analysis and Spearman rank correlation analysis were used to investigate the influence factors of the first cesarean section on the degree of pelvic and abdominal adhesions found during the second cesarean section.Results:The proportion of different degree of pelvic and abdominal adhesions found during the second cesarean section of women within 2 years from the first cesarean section,women with multiple pregnancy when last pregnancy,women with abdominal wall transverse incision when the first cesarean section,women with amniotic fluid contamination when last pregnancy,women with uterine incision tear and unsutured peritoneum when the first cesarean section had increased significantly(P<0.05).The interval between the twice cesarean section was negatively correlated with the degree of pelvic and abdominal adhesions found during the second cesarean section(r=-0.339,P<0.001).The degree of amniotic fluid contamination found during the first cesarean section was positively correlated with the degree of pelvic and abdominal adhesions(r=0.487,P<0.001).During the first cesarean section,amniotic fluid contamination found(β=1.139,OR=3.124,95%CI=1.715-5.690),uterine incision tear(β=0.853,OR=2.347,95%CI=1.189-4.633),and unsutured peritoneum(β=0.373,OR=1.459,95%CI=1.151-1.850)were risk factors of pelvic and abdominal adhesions found in the second cesarean section.Conclusion:To reduce postoperative pelvi

关 键 词：再次剖宫产手术 盆腹腔粘连 羊水污染 子宫切口 危险因素 

分 类 号：R719.8[医药卫生—妇产科学]