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目的:探讨新式子宫体部剖宫产术的临床效果及可行性。方法:采用新式手术方法行子宫体部剖宫产术20例,回顾性分析以往行古典式子宫体部剖宫产术19例,对两种方法术中子宫出血量、产后出血率、子宫切口愈合情况及再次妊娠发生子宫破裂风险性进行评估对比。结果:①新式子宫体部剖宫产术采取钝性分离法分离子宫体部三肌层,使子宫肌层均未被切断,保留了子宫肌纤维的完整性,更重要的是使行走于子宫肌层内的血管未被切断,明显地减少了术中子宫出血量(230.62±58.35)ml。古典式子宫体部剖宫产术将子宫肌层和肌层内的血管全部切断,术中子宫出血量(500.71±212.43)ml,两者比较差异显著(P<0.01)。②新式剖宫产产后出血率为0,与古典式(40%)相比差异显著(P<0.01)。③子宫切口愈合良好,术后7天有86.7%为A型愈合,13.3%为B型愈合,术后30天全部为A型愈合,降低了再次妊娠发生子宫破裂的风险性,也为再次妊娠经阴道分娩创造了有利条件。结论:新式子宫体部剖宫产术更顺应子宫的生理解剖特点,术式简单,安全易掌握,并发症少,优于古典式,具有较高的临床实用价值和可行性。
Objective: To explore the clinical effect and feasibility of cesarean section in the new uterus. Methods: 20 cases of uterine cesarean section were performed by the new surgical method. Nineteen cases of classical uterine cesarean section were retrospectively analyzed. The intraoperative uterine bleeding volume, postpartum hemorrhage rate, uterine incision Healing and uterine rupture occurred again pregnancy risk assessment comparison. Results: ① The new uterine cesarean section adopted blunt separation method to separate the three myometrium of the uterus, which left the myometrium uncut and retained the uterine muscle fiber integrity. More importantly, walking in the uterine muscle Intrahepatic vessels were not severed, significantly reducing intraoperative uterine bleeding (230.62 ± 58.35) ml. Classical uterine cesarean section all the blood vessels in the myometrium and myometrium were cut off, intraoperative uterine bleeding (500.71 ± 212.43) ml, the difference between the two was significant (P <0.01). ② The newborn cesarean section postpartum hemorrhage rate was 0, which was significantly different from the classical (40%) (P <0.01). The uterine incision healed well, 7 days after operation, 86.7% was A-type heal, 13.3% was B-type healed, and all 30 days after operation was A-type heal, which reduced the risk of uterine rupture in the second pregnancy and the second pregnancy Transvaginal delivery has created favorable conditions. Conclusion: The new uterine cesarean section is more compliant with the physiological anatomy of the uterus. It is simple, safe and easy to grasp, with few complications and superior to the classical ones. It has high clinical value and feasibility.