Holmgren G, Sjöholm L, Stark M
Department of Women's and Children's Health, Uppsala University, Sweden.
Acta Obstet Gynecol Scand. 1999 Aug;78(7):615-21.
A method description is given for the Misgav Ladach method for cesarean section. This is based on the Joel-Cohen incision originally introduced for hysterectomy.
The incision is a straight transverse incision somewhat higher than the Pfannenstiel incision. The subcutaneous tissue is left undisturbed apart from the midline. The rectus sheath is separated along its fibres. The rectus muscles are separated by pulling. The peritoneum is opened by stretching with index fingers. The uterus is opened with an index finger and the hole enlarged between the index finger of one hand and the thumb on the other. The uterus is closed with a one-layer continuous locking stitch. The visceral and parietal peritoneal layers are left open. The rectus muscle is not stitched. The rectus sheath is stitched with a continuous non-locking stitch. The skin is closed with two or three mattress sutures. The space in between is apposed with non-traumatic forceps for 5 minutes.
The basic philosophy is to work in harmony with the body's anatomy and physiology and not against them. The method is restrictive in the use of sharp instruments, preferring manual manipulation.
The method gives quicker recovery, less use of post-operative antibiotics, antifebrile medicines and analgesics. There is a shorter anesthetic and shorter working time for the operative team. It is suitable for both emergency and planned operations.
介绍了剖宫产的米斯加夫·拉达赫（Misgav Ladach）方法。该方法基于最初为子宫切除术引入的乔尔-科恩（Joel-Cohen）切口。
切口为一条比耻骨联合上横切口稍高的横向直切口。除中线外，皮下组织不予触动。沿腹直肌鞘纤维进行分离。通过牵拉分离腹直肌。用食指撑开打开腹膜。用食指打开子宫，并用一只手的食指和另一只手的拇指扩大切口。子宫用单层连续锁边缝合关闭。脏腹膜层和壁腹膜层保持开放。腹直肌不缝合。腹直肌鞘用连续非锁边缝合。皮肤用两到三针褥式缝合关闭。中间间隙用无损伤钳夹闭5分钟。
基本理念是顺应身体的解剖结构和生理机能，而非与之相悖。该方法限制锐器的使用，更倾向于手法操作。
该方法恢复更快，术后抗生素、退烧药和镇痛药的使用量更少。手术团队的麻醉时间和手术时间更短。它适用于急诊手术和择期手术。
