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目的:探讨纵切口子宫下段剖宫产、新式剖宫产、改良式新式剖宫产术后第3次剖宫产腹壁及腹腔粘连情况。方法:选择纵切口子宫下段剖宫产术后第3次手术为研究组,新式剖宫产及改良式剖宫产术后第3次手术为对照组,第3次手术均为原切口开腹剖宫产。对比三组术式腹壁及腹腔粘连情况,开腹时间、手术开始至胎儿取出时间手术时间。结果:研究组与对照组腹壁各层及腹腔粘连及开腹时间、手术时间比较,差异均有显著性,而取出胎儿时间差异无显著性。结论:新式剖宫产不缝合腹膜可使腹直肌与子宫致密粘连再次手术分离粘连时间长,腹直肌损伤大,下段无法暴露[1],多数采用例“T”字形切口切开子宫,改良式剖宫产第3次手术腹壁各层粘连严重,均较第2次手术明显开腹困难。纵切口子宫下段剖宫产腹壁各层均有粘连,但开腹均较对照组容易,腹腔粘连情况改良式剖宫产及纵切口子宫下段剖宫产均无明显差别,故在基层医院针对可以多胎妊娠,且需剖宫产的产妇推荐使用纵切口子宫下段剖宫产。
OBJECTIVE: To investigate the abdominal wall and abdominal adhesions of the third cesarean section after longitudinal incision cesarean section, new cesarean section and modified new cesarean section. Methods: The third operation after cesarean section was selected as the study group, the third cesarean section after modified cesarean section and the third operation after modified cesarean section as the control group. The third operation was performed on the first incision Cesarean section. Contrasting the three groups of abdominal wall and abdominal adhesions, laparotomy time, surgery to fetus removal time operation time. Results: There were significant differences in the abdominal wall adhesion and laparotomy time and operation time between the study group and the control group, while no significant difference was found in fetus fetus time. Conclusion: The new cesarean section does not suture the peritoneum can make the rectus abdominis and uterine tight adhesions reoperation adhesions for a long time, large rectus abdominis injury, the lower segment can not be exposed [1], the majority of cases using Uterus, modified cesarean section of the abdominal wall of the third operation of severe adhesion, were significantly more difficult than the second open surgery. Longitudinal incision in the lower uterine segment of the abdominal wall cesarean section adhesions, but the laparotomy are easier than the control group, abdominal adhesions improved cesarean section and longitudinal incision cesarean section of the lower uterine segment were no significant differences, so in primary care hospitals for Multiple pregnancies, and cesarean section maternal recommendation to use the longitudinal incision of the lower uterine segment cesarean section.