Hamel Kelly J
Department of Obstetrics and Gynecology, University of South Florida, Tampa, Florida, USA.
Am J Obstet Gynecol. 2007 May;196(5):e31-2. doi: 10.1016/j.ajog.2006.09.011.
To compare the incidence and severity of adhesions at repeat cesarean delivery based on the closure at primary section.
A retrospective chart review was conducted for 62 cases of repeat cesarean sections. A score was assigned based on the severity of adhesions. The primary operative report was reviewed, and the closure type recorded. Statistical analysis was performed with a t test, chi2, and ANOVA.
Forty-nine and eight-tenths percent of cases had extensive adhesions. Closure of the peritoneal or rectus abdominis muscle resulted in significantly fewer extensive adhesions than nonclosure (31.2% vs 70.0%; P = .013). The mean adhesion score for the nonclosure group was 2.67, compared with 1.91 for the parietal peritoneal closure group (P = .044) and 1.73 for the rectus muscle group (P = .009), where 1 is no adhesions and 4 is the most severe).
Closure of the rectus muscle or the parietal peritoneum at primary section resulted in significantly fewer adhesions at repeat cesarean delivery.
根据初次剖宫产时的缝合方式，比较再次剖宫产时粘连的发生率和严重程度。
对62例再次剖宫产病例进行回顾性病历审查。根据粘连严重程度进行评分。复查初次手术报告并记录缝合类型。采用t检验、卡方检验和方差分析进行统计分析。
49.8%的病例有广泛粘连。缝合腹膜或腹直肌导致广泛粘连的病例明显少于未缝合者（31.2%对70.0%；P = 0.013）。未缝合组的平均粘连评分为2.67，而壁腹膜缝合组为1.91（P = 0.044），腹直肌组为1.73（P = 0.009），其中1表示无粘连，4表示最严重）。
初次剖宫产时缝合腹直肌或壁腹膜可使再次剖宫产时粘连明显减少。
