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目的分析再次剖宫产孕产妇前次手术后腹壁、盆腹腔粘连及子宫切口情况,评价前次手术效果。方法前次剖宫产孕妇103例来本院再次剖宫产时,观察研究前次手术后腹壁和盆腹腔粘连及子宫切口情况,以及首次手术有关因素对其的影响。结果腹部纵、横切口分别占31.1%(32/103)和68.9%(71/103);腹壁无粘连(23.30%)、轻度粘连(47.57%)、重度粘连(29.13%);盆腹腔无粘连(35.92%)、轻度粘连(35.92%)、重度粘连(28.16%);术后腹壁、盆腹腔粘连分别占76.70%、64.08%。原子宫切口完整、不全破裂分别占98.06%、1.94%。横切口子宫下段剖宫产腹壁粘连重于纵切口子宫下段剖宫产(z=-6.337,P<0.05),而盆腹腔粘连情况横切口子宫下段剖宫产重于纵切口子宫下段剖宫产(z=-8.303,P<0.05);手术腹壁、盆腹腔粘连情况三级医院优于一级、二级医院(H值分别为79.343和86.543,均P<0.05);剖宫产术后5.1~9年的腹壁粘连(80.00%)及重度粘连(37.14%)发生率高;剖宫产术后5.1~16年的术后盆腹腔粘连(70.83%)及重度粘连发生率高(35.41%)。结论腹壁粘连、盆腹腔粘连与剖宫产术及其术式本身的损伤、孕产妇个体状况及首次剖宫产术前后的盆腔感染等综合因素有关。子宫切口情况与首次剖宫产间隔年限有关,短于2年再次妊娠时妊娠晚期子宫原瘢痕易破裂,不宜阴道试产。
Objective To analyze the situation of abdominal wall, pelvic adhesions and uterine incision in the second cesarean section before operation and evaluate the effect of the previous operation. Methods 103 cases of cesarean section during the previous cesarean section to another cesarean section, observed and studied the abdominal wall and abdominal adhesions and uterine incision after the previous operation, and the impact of the first surgery related factors. Results Abdominal longitudinal and transverse incisions accounted for 31.1% (32/103) and 68.9% (71/103) respectively. There were no adhesions in the abdominal wall (23.30%), mild adhesions (47.57%) and severe adhesions (29.13%). (35.92%), mild adhesions (35.92%) and severe adhesions (28.16%). Postoperative abdominal wall and pelvic adhesions accounted for 76.70% and 64.08% respectively. The uterine incision intact, incomplete rupture accounted for 98.06%, 1.94%. The transverse incision cesarean section abdominal wall adhesions than in the longitudinal incision of the lower uterine segment cesarean section (z = -6.337, P <0.05), while the abdominal adhesions abdominal incision cesarean section lower than the lower uterine segment cesarean section (H = 79.343 and 86.543, respectively, P <0.05); after the cesarean section 5.1 The incidence of abdominal adhesions (80.00%) and severe adhesion (37.14%) was high in 9 to 9 years. The rates of pelvic adhesions (70.83%) and severe adhesions 5.11 to 16 years after cesarean section were high (35.41% . Conclusions Abdominal adhesions, abdominal adhesions and cesarean section and its surgical injury itself, maternal individual conditions and the first cesarean section before and after pelvic infection and other comprehensive factors related. Uterine incision with the first cesarean section interval related to shorter than 2 years of pregnancy again when the third trimester uterine scar easily ruptured, vaginal trial should not be.