腹壁横纵切口对于二次剖宫产的影响.docx

腹壁横纵切口对于二次剖宫产的影响[Abstract]ObjectiveToapproachinfluenceofabdominaltransverseincisionandlongitudinalincisionforsecondarycesareandelivery.MethodsTheclinicaldataof1800caseswithsecondarycesareandeliveryadmittedtoDepartmentofObstetricsMianyangPeople'sHospitalfromJanuary2012toJanuary2015wereanalyzedbothgroupsweretakentheoriginaloldincisionsurgeryandtheyweredividedintotwogroupsbyprimarycesareandeliverywaywith900casesinabdominaltransverseincisiongroupand900casesinabdominallongitudinalincision.Thefetalchildbirthtimeoperationtimeintraoperativebloodlossoftwogroupswereobserved；thematernalpelvicadhesionabdominalincisionhealingoftwogroupswerecompared；theneonatalscoreandfamilysatisfactionoftwogroupswereanalyzed.ResultsThefetalchildbirthtime[（8.4±2.0）min]operationtime[（34.3±4.5）min]intraoperativebloodloss[（233.8±15.6）mL]ofabdominallongitudinalincisiongroupwerelowerthanthoseofabdominaltransverseincisiongroup[（12.5±4.4）min（39.0±6.0）min（254.8±21.1）mL]thedifferenceswerestatisticallysignificant（P<0.05）；thematernalpelvicadhesionrate（20.2%）ofabdominallongitudinalincisiongroupwaslowerthanthatofabdominaltransverseincisiongroup（55.6%）theclassAhealingrate（80.0%）ofmaternalabdominalincisioninabdominallongitudinalincisiongroupwashigherthanthatofabdominaltransverseincisiongroup（44.9%）thedifferenceswerestatisticallysignificant（P0.05）thefamilysatisfaction（95%）ofabdominallongitudinalincisiongroupwashigherthanthatofabdominaltransverseincisiongroup（70%）thedifferencewasstatisticallysignificant（P0.05）具有可比性。1.2方法两组产妇均按照原来的腹壁旧切口进行手术。腹壁横切口组：在原来剖宫产的腹壁横切口处位置做一个切口根据胎儿大小对切口进行调整。在切口中段将皮下脂肪3cm位置切开到达筋膜层通过食指和中指插入将上下皮下组织撕开在切口正中将腹直肌前鞘大约3cm位置横形切开然后再通过组织剪向上抬起将膜直肌前鞘剪开保证其长度和切口长度一致通过弯钳在中线处将两侧腹直肌和腹膜前约3cm的部位分开促使腹膜暴露将腹膜撕开通过剪刀将腹膜切口向两侧进行延长。将子宫膀胱切开反折腹膜向着两侧方