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目的探讨影响剖宫产手术发生子宫切口裂伤的因素,以采取相应的预防对策。方法收集2014~2015年成都市第二人民医院妇产科采取剖宫产分娩的1 762例产妇的临床资料,分析影响剖宫产手术发生子宫切口裂伤的因素。结果子宫切口裂伤81例,占4.60%。经Logistic回归分析,宫口扩张≥8 cm、术前先露S≥+3、枕后位、子宫下段形成差、瘢痕子宫、新生儿体重≥4 kg、胎位为臀位是影响剖宫产手术发生子宫切口裂伤的独立因素。在切口位置上,当切口距离膀胱子宫返折>3 cm时,裂伤率高于<3 cm时的距离(P<0.05);而在扩大子宫切口方式上,钝性切口裂伤率远高于采用钝性加锐性切口的裂伤发生率(P<0.05)。结论剖宫产手术切口裂伤发生与手术时机、先露位置、子宫手术史、胎儿体重、胎方位、切口位置、手术技巧相关,剖宫产术前应充分评估胎儿体重,产时及时纠正胎位不正及胎方位,把握手术时机,严格掌握剖宫产指征,提高手术技巧,以减少剖宫产术子宫切口裂伤的发生。
Objective To explore the factors influencing cesarean section incision laceration in cesarean section in order to take appropriate preventive measures. Methods The clinical data of 1 762 pregnant women who were delivered by cesarean section in Department of Obstetrics and Gynecology, Second People ’s Hospital of Chengdu from 2014 to 2015 were collected to analyze the influencing factors of laceration of uterine incision in cesarean section. Results 81 cases of uterine incision laceration, accounting for 4.60%. Logistic regression analysis, cervix expansion ≥ 8 cm, preoperative revealed S ≥ +3, occiput posterior position, the formation of the lower uterine segment poor, scar uterus, newborn weight ≥ 4 kg, fetal breech is the impact of cesarean section Uterine incision laceration of the independent factors. At the incision site, the rate of laceration was higher than that of <3 cm (P <0.05) when the incision was> 3 cm away from the uterus of the bladder. However, in the mode of expanding the uterine incision, the incidence of blunt incision was far higher The incidence of laceration with blunt incision and incision (P <0.05). Conclusion Cesarean section incision laceration and operation timing, first exposed position, history of uterine surgery, fetal weight, fetal position, incision position, surgical skills related to cesarean section should be fully assess the preterm fetal weight, birth and timely correction of fetal position Unfair and fetal position, grasp the timing of surgery, strict control of cesarean indications and improve surgical skills to reduce the incidence of incisional cesarean section incision laceration.