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我院1983年2月至1984年2月采用顶一双侧联合法行腹膜外剖宫产术35例,现将手术方法介绍如下: 手术方法 1.显露膀胱:取下腹正中切口,其下缘达耻骨联合,分离腹直肌,并将锥状肌部分肌腱剪开,使切口下部充分暴露。分离腹横筋膜及浅表脂肪,则双侧膀胱侧壁的弧形界限可显露。 2.切开膀胱前筋膜。于膀胱顶下2.5cm处切开,切开深度以接近膀胱肌层或暴露膀胱肌层为度,并将切口向两侧扩大,直达膀胱侧缘。 3.分离第一反折:将膀胱前筋膜切口上缘用止血钳提起,用钝性分离法向上推移,使之与膀胱肌层分开。此时随前筋膜一起,第一腹膜反折(腹壁膀胱腹膜反折或前反折)也与膀胱肌层分离。在分离过程中,可发现两侧分离较容易,而中间进行较困难。
Our hospital from February 1983 to February 1984 using the top and the bilateral unilateral cesarean section in 35 cases, now the surgical methods are described below: surgical methods 1. Revealed the bladder: remove the median incision, the lower edge of its lower edge Up to pubic symphysis, separation of the rectus abdominis, and part of the tendon of the pyramidal muscle scissors, the lower part of the incision fully exposed. Separation of the transverse fascia and superficial fat, the bilateral border of the bladder wall can be revealed. 2. Cut the anterior bladder fascia. 2.5cm at the top of the bladder incision, incision depth close to the bladder muscle layer or expose the bladder muscle for the degree, and the incision to both sides of the expansion, direct bladder lateral margin. 3. Separation of the first reflex: the upper edge of the anterior bladder incision with hemostatic forceps lift up, with a blunt dissection up the shift so that the bladder muscle layer separately. At this point with the former fascia, the first peritoneal fold (abdominal wall peritoneal fold or pre-reflex) with the bladder muscle layer separation. In the separation process, it can be found that separation on both sides is easier and more difficult in the middle.