二次剖宫产术中分离盆腔粘连技巧与子宫切口的选择  

Separation of pelvic adhesions and choice of uterine incision in second cesarean section

作　　者：王培萍 姜倩[1] 杜超 李晴[1] 孙君 Wang Peiping;Jiang Qian;Du Chao;Li Qing;Sun Jun(Department of Obstetrics and Gynecology,PLA 63600Military Hospital,Lanzhou Gansu,732750,China)

机构地区：[1]中国人民解放军63600部队医院妇产科,甘肃兰州732750

出　　处：《中外女性健康研究》2022年第14期71-72,共2页Women＇s Health Research

摘　　要：目的:通过分析二次剖宫产术中分离盆腔粘连的技巧和不同子宫切口的优缺点,梳理出较为合理的处理方式。方法:在二次剖宫产术中将部分分离盆腔粘连和原子宫切口上1~2cm处为子宫切口的设为观察组,将充分分离盆腔粘连和原子宫切口为子宫切口的设为对照组,对两组二次剖宫产术中腹直肌的损伤程度、粘连分离程度、不同子宫切口的效果、出血量、子宫切口撕裂、新生儿窒息、出头困难等情况进行对比。结果:与对照组相比,观察组分离粘连程度降低,腹直肌损伤程度降低,产妇疼痛程度较低,发热率较低,缝合腹膜可降低盆腔粘连程度,取原子宫切口上方1~2cm为子宫切口,可降低子宫出血率、子宫切口撕裂率,降低缝合子宫切口的困难程度和胎儿出头困难情况,组间有明显差异,P<0.05。结论:二次剖宫产术中尽量减少盆腔粘连分离范围,关腹时缝合腹膜,子宫切口应尽量选择原切口上方1~2cm处为佳。Objective:To analyze the technique of separating pelvic adhesion and the advantages and disadvantages of different uterine incision in secondary cesarean section,and to find out a reasonable treatment method.Methods:The second section was set up to observe the partial separation of pelvic adhesion and 1-2cm above the original incision.The control group was set up to fully separate the pelvic adhesion and the original incision as the incision.The injury degree,degree of adhesion separation,effect of different incision,bleeding,incision tearing,neonatal asphyxia,head emergence difficulty,etc.were treated as control group contrast.Results:The study group reduced the degree of separation adhesion,reduced the injury of rectus abdominis muscle,reduced the pain degree of the pregnant women,reduced the fever rate,sutured peritoneum can reduce the degree of pelvic adhesion.Taking 1-2cm above the original uterine incision as the incision,it can reduce the rate of uterine bleeding,the rate of incision tear,the difficulty of suture the incision and the difficulty of fetal hair emergence,which is significantly different from the control group,P<0.05。Conclusion:The scope of pelvic adhesion separation should be reduced as much as possible during secondary cesarean section.When closing abdomen,the best choice of the incision should be 1-2cm above the original incision.

关 键 词：二次剖宫产术 盆腔粘连 子宫切口 

分 类 号：R714.3[医药卫生—妇产科学]