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目的探讨瘢痕子宫患者发生腹腔粘连的危险因素以及对再次剖宫产术的影响。方法选择马鞍山十七冶医院2013年6月至2015年12月263例瘢痕子宫剖宫产产妇中存在腹腔粘连的78例患者为粘连组,同期接受子宫下段剖宫产术术中未见腹腔粘连的78例孕妇为无粘连组,采用多因素Logistic回归分析在年龄、两次剖宫产时间间隔、上次剖宫产医院级别、手术切口方式、既往盆腔炎史、其他腹腔手术史、多次剖宫产史、妊娠期高血压疾病等因素中确认导致瘢痕子宫剖宫产术腹腔粘连危险因素,并比较两组患者术中相关情况。结果上次剖宫产医院级别低于二甲,原手术切口为横切口,盆腔炎史和既往多次剖宫产史为瘢痕子宫剖宫产术腹腔粘连的危险因素。粘连组手术时间、术中出血量明显增加(P<0.05),新生儿取出困难、新生儿窒息、周围组织损伤发生明显增多(P<0.05)。结论临床上应重视上次剖宫产医院级别,原手术切口方式,盆腔炎史及多次剖宫产史等瘢痕子宫腹腔粘连危险因素的识别,做到提前预防,积极应对,以降低对再次剖宫产的影响。
Objective To investigate the risk factors of peritoneal adhesions in patients with uterine scar and the effect of cesarean section. Methods Seventy-eight patients with intra-abdominal adhesions in caesarean section of 263 cases of scarred uterus from July 2013 to December 2015 in Ma’anshan hospital were treated as adhesion group. No intra-abdominal adhesions were observed during the same period of uterine cesarean section 78 cases of pregnant women without adhesion group, using multivariate logistic regression analysis in age, two cesarean section interval, the last cesarean section, surgical incision, history of previous pelvic inflammatory disease, other abdominal surgery history, multiple Cesarean section history, hypertensive disorder complicating pregnancy and other factors to identify the risk factors for cesarean section cesarean section abdominal adhesions, and compared the two groups of patients during surgery. Results The hospital level of caesarean section was lower than that of the former. The former surgical incision was transverse incision, the history of pelvic inflammatory disease and the history of previous cesarean section were the risk factors for celiac abdominal adhesions of scar tissue. In the adhesion group, the operation time, intraoperative blood loss were significantly increased (P <0.05), difficulty in removing the newborn, asphyxia of the newborn and the surrounding tissue injury were significantly increased (P <0.05). Conclusions In the clinic, attention should be paid to the identification of the risk factors of peritoneal adhesions such as the history of cesarean section, original surgical incision, history of pelvic inflammatory disease and multiple cesarean sections in clinical practice so as to prevent and respond positively to the reduction Effect of cesarean section.