Hull D B, Varner M W
Department of Obstetrics and Gynecology, University of Utah College of Medicine, Salt Lake City.
Obstet Gynecol. 1991 Jun;77(6):818-21.
This study was conducted to test the hypothesis that nonclosure of the visceral and parietal peritoneum during low transverse cervical cesarean delivery is not associated with increased intraoperative or immediate postoperative complications. One hundred thirteen patients scheduled for low transverse cervical cesarean were randomized to either closure of both the visceral and parietal peritoneum with absorbable suture (N = 59) or no peritoneal closure (N = 54). Patients were cared for in the usual postoperative manner without reference to treatment group. There were no demographic differences between the groups and no differences in method(s) of anesthesia, operative indication(s), or use of peripartum epidural narcotics. The incidence of fever, endometritis, or wound infection was similar between groups. There were no differences in the number of patients requiring parenteral narcotic analgesia or in the number of doses per patient. The number of oral analgesic doses was significantly greater with closure than without (P = .014). The frequency with which postoperative ileus was diagnosed in each group was similar, and there was no difference regarding the day on which patients were advanced to liquid or select diets. Bowel stimulants were administered more frequently to the closure than to non-closure patients (P = .03). The average operating time was shorter for the open group than for the closure group (P less than .005). We conclude that non-closure of the visceral and parietal peritoneum at low transverse cervical cesarean delivery appears to have no adverse effect on immediate postoperative recovery, may decrease postoperative narcotic requirements, allows less complicated return of bowel function, and provides a simplified and shorter surgical procedure.
低位横切口子宫下段剖宫产术中不缝合脏腹膜和壁腹膜不会增加术中或术后即刻并发症的发生风险。113例计划行低位横切口子宫下段剖宫产的患者被随机分为两组，一组用可吸收缝线缝合脏腹膜和壁腹膜（N = 59），另一组不缝合腹膜（N = 54）。患者术后按常规方式护理，不考虑治疗分组。两组患者在人口统计学特征、麻醉方法、手术指征或围产期硬膜外使用麻醉性镇痛药方面均无差异。两组患者发热、子宫内膜炎或伤口感染的发生率相似。两组患者需要胃肠外麻醉性镇痛药的人数及每位患者的用药剂量均无差异。缝合组口服镇痛药的剂量显著高于不缝合组（P = .014）。两组术后肠梗阻的诊断频率相似，患者开始进流食或特定饮食的时间也无差异。缝合组使用肠道兴奋剂的频率高于不缝合组（P = .03）。开放组的平均手术时间短于缝合组（P < .005）。我们得出结论，低位横切口子宫下段剖宫产术中不缝合脏腹膜和壁腹膜似乎对术后即刻恢复没有不良影响，可能会减少术后麻醉药物的需求，使肠道功能恢复更简单，并且手术操作更简化、时间更短。
