首次剖宫产术式对高龄孕妇再次剖宫产手术影响分析.docVIP

首次剖宫产术式对高龄孕妇再次剖宫产手术影响分析 　　【基金项目】浙江省医药卫生科技计划项目(2011KYB125)。 　　【第一作者简介】池鸿斐（1973-），女，副主任医师，主要从事妇产科临 　　床诊治与研究工作 　　DOI:10.3969/j.issn.1672-1993.2014.07.006 　　【摘要】目的:分析首次剖宫产术式对高龄孕妇再次剖宫产手术的影响，指导远期安全性更佳的首次剖宫产术式的选择。方法:选取我院2010年9月至2013年9月收治的再次行剖宫产高龄产妇277例，按照其首次剖宫产术式分为传统腹壁纵切口A组（n=151）及新式腹壁横切口B组（n=126），比较两组孕妇再次剖宫产的妊娠结局。结果:A组手术时间、术中出血量、肛门排气时间及住院时间均低于B组，两组数据比较存在统计学差异（P＜0??05）；A组孕妇共发生78例腹腔粘连，发生率51??7%，B组发生100例，发生率79??4%，A组腹腔粘连发生率显著低于B组（P＜0??05），且其粘连分度亦显著低于后者；A组产后出血5例，发生率3??3%，B组产后出血9例，发生率7??1%，两组新生儿均未发生窒息，两组孕妇产后出血发生率无明显统计学差异（P＞0??05）。结论:首次剖宫产术式的选择可影响孕妇再次剖宫产并发症的发生率，新式剖宫产术对有再次剖宫产意愿的孕妇风险更高，可导致其手术时间增加、出血量上升、并发症风险增高，而传统剖宫产术可有效规避上述风险。 　　【关键词】剖宫产；术式；高龄孕妇；影响 　　Effect of primary caesarean section on re-caesarean operation of advanced pregnant womenCHI Hongfei1, ZHAO Xiaofeng2. 1. Department of Obstetrics and Gynecology, Ruian Maternal and Child Care Hospital, Wenzhou 325200, China; 2. Department of Gynecology, Zhejiang Province People’s Hospital, Hangzhou 310014, China 　　【Abstract】Objectives: To analyze the effect of primary cesarean section on re-cesarean operation of advanced pregnant women, guiding the choice of primary cesarean section with better and long-term safety. Methods: 277 advanced pregnant women admitted to our hospital from September 2012 ~ September 2013 for re-cesarean operation were divided into group A (n=151) and group B (n=126) according to the primary cesarean section, i.e. those adopted the traditional abdominal vertical incision and new transverse abdominal incision were group A and B respectively. The pregnancy outcome of the two groups was compared after re-cesarean operation. Results: The operation time, intraoperative blood loss anal exhaust time and hospital stays of group A were lower than those of group B, with statistically significant difference (P0.05); no neonatal asphyxia occurred in the two groups. Conclusion: The primary cesarean section may affect the incidence rate of complications after re-cesarean operation. Compared with traditional cesar