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目的对腹部纵横切口二次剖宫产进行临床对比研究,评估何种手术方式更为安全。方法择期二次剖宫产患者142例,其中腹部纵切口组(A组71例),腹部横切口组(B组71例)。两组均采用腰硬联合麻醉,均采用原手术切口,进入腹腔后均行子宫下段剖宫产。观察指标:腹腔粘连程度、从开腹到胎儿娩出时间、总手术时间、术中出血量及切口愈合情况。结果对无或轻度腹腔粘连患者,A组与B组对比上述指标比较差异无统计学意义(P>0.05);对中度或重度腹腔粘连患者,A组与B组对比从开腹到胎儿娩出时间、总手术时间、术中出血量差异有统计学意义(P<0.05),其余指标差异无统计学意义(P>0.05)。结论首次剖宫产术式的选择对二次剖宫产手术操作的影响要根据不同的情况选择才可降低新生儿窒息率。
Objective To compare the clinical results of abdominal cesarean section with abdominal cesarean section incision to evaluate which operation method is safer. Methods Elective 142 cases of secondary cesarean section, including abdominal longitudinal incision group (A group 71 cases), abdomen transverse incision group (B group 71 cases). Both groups were using combined spinal and epidural anesthesia, using the original surgical incision, into the abdominal cavity underwent uterine cesarean section. Observed indicators: the degree of abdominal adhesions, from the opening to the fetal delivery time, the total operation time, intraoperative blood loss and incision healing. Results There was no significant difference in the above indexes between group A and group B (P> 0.05) in patients without or with mild abdominal adhesions. In patients with moderate or severe abdominal adhesions, the contrast between group A and group B was from open to fetus The time of delivery, the total operation time and the amount of intraoperative blood loss were statistically significant (P <0.05). There was no significant difference between the other indexes (P> 0.05). Conclusion The effect of the first choice of cesarean section on the surgical operation of secondary cesarean section should be based on different conditions to reduce neonatal asphyxia.