不同剖宫产术式对产妇盆腹腔及腹壁粘连的对比研究刘秀军（玉田县计划生育中心医院河北玉田064199）【摘要】目的：探讨不同剖宫产术式对产妇盆腹腔及腹壁粘连的影响。方法：115例行再次剖宫产的产妇，根据首次剖宫产的术式不同分为Stark式剖宫产组（62例）和下腹纵切口式剖宫产组（53例）。观察并评价两组产妇首次剖宫产切U的愈合情况，粘连的部位及程度，记录再次剖宫产术时的幵腹时间、手术时间及术中出血量。结果：Stark式剖宫产组切口愈合较好，瘢痕纤细率（87.10%）显著高于下腹纵切口式剖宫产组（30.19%）^&1!;0.05），粘连发生率［4.84%（3/62）］显著低于下腹纵切U式剖宫产组［16.98%（9/53）］（P<0.05）,大网膜与腹壁切口粘连（3.23%）、大网膜与子宫下段粘连（1.61%）、膀胱与子宫中段粘连（0）及膀胱与子宫下段粘连（0）的发生率均显著低于下腹纵切口式剖宫产组（7.55%、3.77%、3.77%、1.89%）（P<0.05）。Stark式剖宫产组开腹时间较下腹纵切口式剖宫产组长（P<0.05）,术中出血量较下腹纵切口式剖宫产组大（P<0.05）,但两组手术时间无显著差异（P>0.05）o结论：Stark式剖宫产术虽然存在术中出血量较大的可能，但其在切U愈合、减少盆腹腔及腹壁粘连方面均较传统的下腹纵切口式剖宫产术只有明显的优势，对产妇再次剖宫产的影响较小，值得临床推广使用。【关键词】剖宫产；产妇；粘连；再次手术；对比研究【中图分类号1R719.8【文献标识码】A【文章编号】1004-6194（2015）01-0213-02Comparativestudyofdifferentmethodsofcesareansectionontheinfluenceofintra-abdominaladhesionandabdominalwalladhesionsofparturients【Abstract】Objective:Toinvestigatetheinfluenceofdifferentmethodsofcesareansectiononintra-abdominaladhesionandabdominalwalladhesionsofparturients.Methods:Atotalof115parturientsperformedrepeatedcesareanweredividedintoStarkgroup(receivedStarkcesareansection,62cases)androutinegroup(receivedlongitudinalincisioncesareansection).Thehealingofincisionforpreviouscesareansection,locationanddegreeofadhesionofthetwogroupswereobservedandevaluated,theopenproceduretime,operationtimeandperioperativebloodlossofthetwogroupswererecorded.Results:Starkgroupshowedabetterrecoveryofhealingofincision,thefinescarratewas87.10%,whichwassignificantlyhigherthanthatof30.19%inroutinegroup(P<0.05);theincidenceofadhesionwas4.84%(3/62),whichwasstatisticallylowerthanthatof16.98%(9/53)inroutinegroup(P<0.05),amongthem,theincidencesofadhesionbetweencolicomentumandabdominalwall(3.23%)aswellasloweruterinesegment(1.61%),betweenbladderandmiddleuterinesegment(0)aswellasloweruterinesegment(0)wereallobviouslylowerthanthoseof7.55%,3.77%,3.77%and1.89%inroutinegroup(P<0.05).TheopenproceduretimeofStarkgroupwasstatisticallylongerthanthatofroutinegroup(P<0.05),perioperativebloodlosswasstatisticallylessthanthatofroutinegroup(P<0.05),butnostatisticaldifferenceinoperationtimewasobservedbetweenthetwogroups(P>0.05).Conclusion:AlthoughStarkcesareansectionhasmoreperioperativebloodloss,ithasobviousadvantagesinrecoveryofincision,reducingintra-abdominaladhesionandabdominalwalladhesionsthanlongitudinalincisioncesareansection,andhassmallinfluenceonrepeatedcesareanofparturients,thusitisworthyofextensivelyappliedinclinic.【Keywords]cesareansection;parturients;adhesion;repeatedsurgery;comparativestudy剖宫产是处理高危妊娠和解决难产、挽救孕产妇和围生儿生命的冇效手段。但剖宫产率上升到一定水平后，围生儿病死率并未继续下降[1-2],同吋，与阴道分娩相比，剖宫产产妇死亡的相对危险回升。近年来，剖宫产率在全球均逐年上升，在我国更为突出，多数孕产妇及其家属对剖宫产的认识存在很大的局限性，普遍对分娩存在恐惧心理，孕妇害怕产痛和母儿安全，产前教育和围产...