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目的探讨Stark式剖宫产术后腹膜及膀胱腹膜反折愈合及粘连发生情况。方法采用回顾性分析的方法,对剖宫产术后二次开腹手术患者腹膜及膀胱腹膜反折粘连发生情况进行观察。其中,Stark式剖宫产术后二次开腹手术89例(A组),下腹纵切口式剖宫产术后二次开腹手术212例(B组),Pfannenstiel切口式剖宫产术后二次开腹手术52例(C组)。比较3组患者剖宫产术后腹壁切口愈合情况以及腹直肌、腹膜、大网膜、膀胱腹膜反折愈合及粘连发生情况。结果(1)腹壁切口愈合良好,瘢痕纤细A组86.5%(77/89),B组29.3%(62/212),C组75.0%(39/52);(2)腹直肌粘连A组25.8%(23/89),B组53.8%(114/212),C组13.5%(7/52);(3)大网膜粘连A组13.5%(12/89),B组56.1%(119/212),C组25.0%(13/52);(4)腹膜粘连A组15.7%(14/89),B组46.2%(98/212),C组11.5%(6/52);(5)腹膜未愈合仅C组有1例,A组与B组均为0;(6)膀胱腹膜反折粘连A组15.7%(14/89),B组55.2%(117/212),C组13.5%(7/52)。腹壁切口愈合及腹直肌、大网膜、腹膜、膀胱腹膜反折粘连情况,A组明显优于B组,两组比较,差异有统计学意义(P<0.05);A组与C组比较,差异无统计学意义(P>0.05)。结论Stark式剖宫产在腹壁切口愈合,减少腹直肌、大网膜、腹膜、膀胱腹膜反折粘连方面明显优于下腹纵切口式剖宫产;虽然与Pfannenstiel切口式剖宫产相比,差异无显著性,但Stark式剖宫产具有诸多公认的优点,值得推广。
Objective To investigate the peritoneal and bladder peritoneal healing and adhesions after Stark cesarean section. Methods The retrospective analysis was used to observe the occurrence of retroperitoneal and peritoneal adhesions in patients undergoing open cesarean section after secondary laparotomy. Among them, 89 cases of secondary laparotomy after Stark cesarean section (group A), 212 cases of secondary laparotomy (group B) after abdominal celiotomy, Pfannenstiel incision cesarean section Secondary laparotomy in 52 cases (C group). The healing of abdominal incision after cesarean section and the occurrence of rectus abdominis, peritoneum, omentum, peritoneal fold healing and adhesions were compared between the three groups. Results: (1) The incision of the abdominal wall healed well, the stenosis group was 86.5% (77/89) in group A, 29.3% (62/212) in group B and 75.0% (39/52) in group C. (2) 25.8% (23/89) in group B, 53.8% (114/212) in group B and 13.5% (7/52) in group C. (3) (14/89) in group A, 46.2% (98/212) in group B, and 11.5% (6/52) in group C; (5) There was only 1 case in the group C and 0 in group A and group B, respectively. (6) 15.7% (14/89) in group A, 55.2% (117/212) in group B, Group C 13.5% (7/52). The healing of abdominal wall incision and rectus abdominis, omentum, peritoneum, bladder peritoneal adhesions, A group was significantly better than the B group, the two groups, the difference was statistically significant (P <0.05); A group and C group , The difference was not statistically significant (P> 0.05). Conclusions Stark-style cesarean section is significantly superior to the inferior abdominal longitudinal incision in the healing of abdominal incision and reduction of rectus abdominis, omentum, peritoneum and bladder peritoneal adhesions. Although compared with the Pfannenstiel incision cesarean section, No significant difference, but Stark-style cesarean section has many recognized advantages, it is worth promoting.