子宫下段向左弧形切口用于剖宫产胎儿娩出困难的探讨.docVIP

精品论文 参考文献 子宫下段向左弧形切口用于剖宫产胎儿娩出困难的探讨 李洪英 （云南省曲靖市第一人民医院产科 655000） 　　【摘要】目的 探讨剖宫产手术中取子宫下段向左弧形切口用于先露娩出困难的临床应用价值。 方法 选择我院2008年6月至2011年9月收治孕妇228例，术前检查评估有先露高浮，巨大儿，联体双胎，胎头深嵌骨盆等先露娩出困难可能情况存在。将228例患者随机分为两组，试验和对照组个114例，两组患者在年龄、孕周、分娩史、先露娩出困难可能情况上无显著差异（P﹥0.05），两组资料具有可比性。两组患者均采用腰硬联合麻醉，术前准备相同，对照组采用传统手术方法；试验组方法　开腹后于子宫下段膀胱子宫反折腹膜横切一小口，左右分离并稍向下推膀胱，横切子宫下段肌层正中，左右撕开，沿肌纤维环形方向自然延长9-10cm左右，于切口左侧角处，弧形向上剪开3—5cm，人工破膜后娩出胎儿。结果 实验组114例，产后出血3例，胎儿娩出时间30—80s，平均61s，新生儿窒息0例，无切口延裂及晚期产后出血。对照组114例，产后出血13例，胎儿娩出时间68—132s,平均105s，新生儿窒息2例，切口延裂11例，晚期产后出血1例。结论 实验组在胎儿娩出时间，新生儿窒息，产后出血，切口延裂明显少于对照组，差异有显著性，Ｐ﹤0.01。子宫向左弧形切口增大了子宫切口扩张面积，使胎儿能够顺利娩出，避免了因娩出困难所致新生儿窒息的发生，避免了子宫切口延裂，减少了产后出血量，减低了手术副损伤的发生。 　　【关键词】 剖宫产 胎儿娩出困难 子宫切口选择 　　【中图分类号】R714 【文献标识码】A 【文章编号】1672-5085（2013）34-0108-02 　　A Discussion on the Type of Uterine on the Left Arc Incision for Solving the difficulty of fetusesrsquo; Expulsion 　　LI Hong-ying 　　(Qujing No. 1 Peoplersquo;s Hospital, Qujing, Yunnan 655000) 　　【Abstract】 Objective Discussing the extraction of the uterine on the left arc incision to solve the difficulty of presentation expulsion in caesarean operation. Methods Selecting 228 admitted and treated pregnant women in our hospital between 06-2008 and 09-2011, whose fetuses have such potential difficulties of presentation expulsion as presentation, fetal macrosomia, conjoined twins, fetal head deep in pelvis in the examination before operations. The 228 patients are randomly divided into two groups in which the patients have no obvious difference （P﹥0.05）in gestational age, period, delivery record and the difficulty of presentation expulsion. The data obtained in the two groups are comparable. Combined spinal-epidural anesthesia are used, the preparations before operations are same, and the control group use the traditional operation methods. The experimental group use the methods as follows: After the laparotomy, the uterine near the bladder is reflexed and a small cut is transvers