Wallin G, Fall O
Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Br J Obstet Gynaecol. 1999 Mar;106(3):221-6. doi: 10.1111/j.1471-0528.1999.tb08234.x.
To investigate whether a series of changes in the current caesarean section operative routine, based on new knowledge, would be beneficial.
A prospective controlled trial.
Labour ward with approximately 3000 deliveries annually in a suburban area of Gothenburg, Sweden.
Seventy-two pregnant women scheduled for delivery by caesarean section were randomised to either modified Joel-Cohen technique (n = 36) or Pfannenstiel technique (n = 36).
Blood loss during surgery and operating time.
The median estimated intra-operative blood loss was 250 mL in the modified Joel-Cohen group and 400 mL in the Pfannenstiel group (P = 0.026). The proportion of women with > or = 300 mL was 16/36 in the modified Joel-Cohen group vs 28/36 in the Pfannenstiel group (OR 0.229, 95% CI 0.082-0.637). Median operating time was 20 min in the modified Joel-Cohen group compared with 28 min in the Pfannenstiel group (P < 0.001). The proportion of women with > or = 25 min was 1/36 in the modified Joel-Cohen group vs 33/36 in the Pfannenstiel group (OR 0.003, 95% CI 0.000-0.026).
We conclude that the modified Joel-Cohen technique of caesarean delivery reduced intraoperative blood loss and operating time compared with the Pfannenstiel technique.
基于新知识，研究当前剖宫产手术常规操作的一系列改变是否有益。
前瞻性对照试验。
瑞典哥德堡郊区的产科病房，每年约有3000例分娩。
72例计划行剖宫产的孕妇被随机分为改良乔尔-科恩技术组（n = 36）和耻骨联合上横切口技术组（n = 36）。
手术中的失血量和手术时间。
改良乔尔-科恩组术中估计失血量中位数为250 mL，耻骨联合上横切口组为400 mL（P = 0.026）。失血量≥300 mL的女性比例在改良乔尔-科恩组为16/36，耻骨联合上横切口组为28/36（比值比0.229，95%可信区间0.082 - 0.637）。改良乔尔-科恩组手术时间中位数为20分钟，耻骨联合上横切口组为28分钟（P < 0.001）。手术时间≥25分钟的女性比例在改良乔尔-科恩组为1/36，耻骨联合上横切口组为33/36（比值比0.003，95%可信区间0.000 - 0.026）。
我们得出结论，与耻骨联合上横切口技术相比，改良乔尔-科恩剖宫产技术减少了术中失血量和手术时间。
