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目的探讨配合产钳使用的改良式腹膜外剖宫产术的临床应用价值。方法回顾性抽取我院2010年1月～2011年1月实施剖宫产的患者150例(均术前彩超提示头位,且除外子宫附件占位性病变、严重胎儿窘迫、前置胎盘、胎盘附着在子宫下段前壁者),分为3组5,0例作配合产钳使用的改良式腹膜外剖宫产术(A组),40例作腹膜外剖宫产术(B组),60例作腹膜内剖宫产术(C组),观察及比较3组产妇术中情况[总手术时间、从手术开始到胎儿娩出所用的时间、切开子宫到胎儿娩出时间(U-DI)、新生儿Apgar评分]和术后情况(胃肠功能恢复排气时间、伤口疼痛、术后病率等)。结果从手术开始到胎儿娩出所用的时间:腹膜外A、B组较腹膜内C组长,差异无统计学意义(P>0.05),A组与B组比较,差异有统计学意义(P<0.05);3组总手术时间差异无统计学意义(P>0.05);切开子宫到胎儿娩出时间(U-DI)A组最短,差异有统计学意义(P<0.01);新生儿Apgar评分A组最高,差异有统计学意义(P<0.01);腹膜外(A、B)组术后病率(发热、伤口疼痛及腹胀等)明显少于腹膜内(C组)组,差异有统计学意义(P<0.01)。结论配合产钳使用的改良式腹膜外剖宫产术除具有腹膜外剖宫产的优势外,同时还有快速娩出胎儿,减少新生儿窒息,改善围生儿结局的优势,值得临床推广。
Objective To investigate the clinical value of modified extraperitoneal cesarean section in combination with forceps. Methods We retrospectively collected 150 cases of cesarean section from January 2010 to January 2011 in our hospital. All patients underwent preoperative color Doppler echocardiography, with the exception of occupational lesions of the uterus, severe fetal distress, placenta previa, placenta accreta Attached to the anterior wall of the lower uterine segment) were divided into 3 groups of 5,0 cases of modified extraperitoneal cesarean section for use with forceps (group A), 40 cases of extraperitoneal cesarean section (group B), 60 Cases of intraperitoneal cesarean section (C group) were observed and compared three groups of maternal surgery [total operation time, from the beginning of the operation to the time of delivery of the fetus, uterine to fetal delivery time (U-DI), Neonatal Apgar score] and postoperative conditions (gastrointestinal function recovery exhaust time, wound pain, postoperative morbidity, etc.). Results The time from the start of operation to the delivery of the fetus was longer in the extraperitoneal A and B groups than in the intraperitoneal C group (P> 0.05), but there was a significant difference between the A and B groups (P < 0.05). There was no significant difference in total operative time between the three groups (P> 0.05). The U-DI group had the shortest and the difference was statistically significant (P <0.01) The difference was statistically significant (P <0.01). The postoperative rates (fever, wound pain and bloating) in the extraperitoneal (A, B) group were significantly lower than those in the C group Significance (P <0.01). Conclusion In addition to the advantages of using an extraperitoneal cesarean section with forceps in addition to extraperitoneal cesarean delivery, there are also rapid delivery of the fetus, reducing neonatal asphyxia and improving the outcome of perinatal children, which is worthy of clinical promotion.