再次剖宫产子宫下段切口位置选择的临床分析
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摘要
目的探讨瘢痕子宫再次剖宫产子宫下段切口位置选择对手术疗效的影响。方法选择2017年1月至2017年12月在滕州市中心人民医院因瘢痕子宫入院,要求择期剖宫产的单胎妊娠产妇382例,随机平均分为观察组和实验组。观察组191例刀口选择在瘢痕组织上2.0 cm,实验组191例根据子宫下段刀口的位置选择于瘢痕组织上方2.0 cm、瘢痕组织下方1.5 cm、原瘢痕组织处,实验组中76例选择瘢痕组织上方2.0 cm,60例选择瘢痕组织下方1.5 cm,55例选择原瘢痕组织处。比较手术时间、术中出血量、子宫下段撕裂或切口延伸、产后出血、住院时间、子宫复旧等相关指标。结果观察组与实验组的术中出血量、子宫下段撕裂或切口延伸、产后出血、子宫复旧情况相比较,差异有统计学意义(P<0.05),两组手术时间、住院时间相比较,差异无统计学意义。结论瘢痕子宫再次剖宫产合理选择子宫下段切口位置将有效减少术中出血、减少子宫下段撕裂或切口延伸、减少产后出血、促进子宫复旧。
Objective To investigate the influence of the location of incision in the lower uterine segment of scar uterine cesarean section on the surgical effect. Methods During January 2017 to December 2017, because of scar uterus admission requirements marked in the people's hospital of single pregnancy maternal 382 cases were randomly divided into observation group and experimental group, observation group 191 cases of blade choice in 2.0 cm scar tissue, the experimental group 191 cases according to the location of the lower uterine segment blade choice in scar tissue above2.0 cm, 1.5 cm scar tissue below, the original scar,76 patients chose the incision 2.0 cm above the scar tissue, 60 patients chose the incision 1.5 cm below the scar tissue, and 55 patients chose the original scar tissue. The operative time, intraoperative blood loss, lower uterine tear or incision extension, postpartum hemorrhage, hospital stay, uterine involution and other relevant indicators were compared. Results There was statistically significant difference between the observation group and the experimental group in intraoperative blood loss, uterine tear or incision extension, postpartum hemorrhage, and uterine regression(P<0.05), while there was no statistically significant difference in operation time and hospital stay between the two groups. Conclusion Reasonable selection of incision location in the lower uterine segment of scar uterine resection can effectively reduce intraoperative bleeding, reduce the tearing of the lower uterine segment or incision extension, reduce postpartum bleeding, and promote uterine involution.
Objective To investigate the influence of the location of incision in the lower uterine segment of scar uterine cesarean section on the surgical effect. Methods During January 2017 to December 2017, because of scar uterus admission requirements marked in the people's hospital of single pregnancy maternal 382 cases were randomly divided into observation group and experimental group, observation group 191 cases of blade choice in 2.0 cm scar tissue, the experimental group 191 cases according to the location of the lower uterine segment blade choice in scar tissue above2.0 cm, 1.5 cm scar tissue below, the original scar,76 patients chose the incision 2.0 cm above the scar tissue, 60 patients chose the incision 1.5 cm below the scar tissue, and 55 patients chose the original scar tissue. The operative time, intraoperative blood loss, lower uterine tear or incision extension, postpartum hemorrhage, hospital stay, uterine involution and other relevant indicators were compared. Results There was statistically significant difference between the observation group and the experimental group in intraoperative blood loss, uterine tear or incision extension, postpartum hemorrhage, and uterine regression(P<0.05), while there was no statistically significant difference in operation time and hospital stay between the two groups. Conclusion Reasonable selection of incision location in the lower uterine segment of scar uterine resection can effectively reduce intraoperative bleeding, reduce the tearing of the lower uterine segment or incision extension, reduce postpartum bleeding, and promote uterine involution.
引文
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[7]陈晓端,石一复.剖宫产后瘢痕部位相关病变临床及病理改变[J].中华病理学杂志,2016,45(10):731-733.
[8]郭玲平.探讨再次剖宫产如何避免在下段撕裂或切口延裂[J].医药前沿,2015,5(5):76.
[9] Barmberg C, Hinkson L, Henrich W. Cesarean scar niche and uterotomy closure technique[J]. Acta Ob‐stet Gynecol Scand, 2018,97(5):630.
[10]王业平,陈育梅,潘丹,等.再次剖宫产术后修剪子宫切口瘢痕对子宫瘢痕缺损形成的影响[J].中国预防医学杂志,2018,1(19):34-37.
[2]曹蓉,谭琼.多次剖宫产最佳刀口选择的临床分析[J].中国妇幼健康研究,2016,27(3):356-360.
[3] lofrumento DD, DiNardo MA, De Falco M, et al. Uter‐ine wound healing:a complex process mediated by proteins and peptides[J]. Curr Protein Pept Sci,2016,18(2):125-128.
[4]张小平,肖江.剖宫产术中子宫下段切口术式及方法探讨的新进展[J].中国医药,2018,16(19):26-28.
[5]殷丽丽,杨清.剖宫产瘢痕妊娠研究进展[J].中国实用妇科与产科杂志,2015,31(4):361-365.
[6]王美玲,朱剑飞,韩欣宁.剖宫产中复杂子宫下段切开方式探讨[J].四川医学,2014,35(9):1221-1222.
[7]陈晓端,石一复.剖宫产后瘢痕部位相关病变临床及病理改变[J].中华病理学杂志,2016,45(10):731-733.
[8]郭玲平.探讨再次剖宫产如何避免在下段撕裂或切口延裂[J].医药前沿,2015,5(5):76.
[9] Barmberg C, Hinkson L, Henrich W. Cesarean scar niche and uterotomy closure technique[J]. Acta Ob‐stet Gynecol Scand, 2018,97(5):630.
[10]王业平,陈育梅,潘丹,等.再次剖宫产术后修剪子宫切口瘢痕对子宫瘢痕缺损形成的影响[J].中国预防医学杂志,2018,1(19):34-37.