再次剖宫产术后粘连的形成及发病率
Adhesion development and morbidity after repeat cesarean delivery.
作者信息
Tulandi Togas, Agdi Mohammed, Zarei Afsoon, Miner Louise, Sikirica Vanja
机构信息
Department of Obstetrics and Gynecology, McGill University, Montreal, QC, Canada.
出版信息
Am J Obstet Gynecol. 2009 Jul;201(1):56.e1-6. doi: 10.1016/j.ajog.2009.04.039.
OBJECTIVE
The purpose of this study was to evaluate the development and implications of intraabdominal adhesions after repeat cesarean section delivery (CS).
STUDY DESIGN
We reviewed the charts of 1283 women who underwent repeat CS and 203 other women who underwent primary CS. Primary outcome measures were incidence and extent of adhesions, incision-to-delivery interval, and operating time.
RESULTS
No adhesions were found in primary CS. Compared with those women with a second CS (24.4%), significantly more women had adhesions after 3 CSs (42.8%; 95% confidence interval [CI], 0.84-0.99). Compared with a first CS (7.7 +/- 0.3 minutes), the delivery time was significantly longer at subsequent CSs (second CS, 9.4 +/- 0.1 minutes; 95% CI, 1-2; third CS, 10.6 +/- 0.3 minutes; 95% CI, 2-4; >or= 4 CSs, 10.4 +/- 0.1 minutes; 95% CI, 1-2). However, complication rates in those women with >or= 2 CSs were comparable with primary CS.
CONCLUSION
Increased adhesion development and a longer time to delivery were found with each subsequent CS.
目的
本研究旨在评估再次剖宫产术后腹腔粘连的发生情况及其影响。
研究设计
我们回顾了1283例行再次剖宫产术的女性及203例行初次剖宫产术的其他女性的病历。主要观察指标为粘连的发生率和程度、切口至分娩的间隔时间以及手术时间。
结果
初次剖宫产术中未发现粘连。与行二次剖宫产术的女性（24.4%）相比，行三次及以上剖宫产术的女性粘连发生率显著更高（42.8%；95%置信区间[CI]，0.84 - 0.99）。与初次剖宫产术时（7.7±0.3分钟）相比，后续剖宫产术时的分娩时间显著更长（二次剖宫产术，9.4±0.1分钟；95%CI，1 - 2；三次剖宫产术，10.6±0.3分钟；95%CI，2 - 4；四次及以上剖宫产术，10.4±0.1分钟；95%CI，1 - 2）。然而，行两次及以上剖宫产术的女性并发症发生率与初次剖宫产术相当。
结论
随着后续每次剖宫产术，粘连发生率增加，分娩时间延长。
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