Choudhury Arun Paul, Bhadra Banasree, Roy Arunava
Department of Obstetrics and Gynaecology, Silchar Medical College, Silchar 788014.
J Indian Med Assoc. 2010 Aug;108(8):498, 503-4.
Symphysiotomy is an alternative operative procedure where a deliberate division of symphysis pubis is carried out to facilitate delivery in cases of cephalopelvic disproportion, so as to permit the birth of baby by natural passages. Symphysiotomy results in a permanent increase in pelvic diameter (up to 1 cm) by surgically dividing the ligaments of the symphysis under local or general anaesthesia. Symphysiotomy should only be done in a established case of obstructed labour but not in anticipation of obstructed labour. This operation was reviewed in 21 cases of established obstructed labour in Silchar Medical College with little modifications of original operations. All the cases were done by subcutaneous method which is cosmetic and simple. The operation was carried out by dividing upper ligament completely and anterior arcuate ligament partially under local anaesthesia. The posterior arcuate ligament was not touched at all. None of the cases required forceps or vaccum extraction. It resulted in almost negligible complications in comparison to morbidity and mortality in primary caesarean section. Considering the usefulness of the operation it can even be started in rural hospitals by the gynaecologist if they are properly trained to do it in a justified manner in properly selected cases.
耻骨联合切开术是一种替代手术方法，即故意切开耻骨联合，以便在头盆不称的情况下促进分娩，从而使胎儿能够通过自然通道出生。耻骨联合切开术通过在局部或全身麻醉下手术切断耻骨联合的韧带，使骨盆直径永久性增加（可达1厘米）。耻骨联合切开术仅应在确诊为梗阻性分娩的情况下进行，而不应在预期有梗阻性分娩时进行。在锡尔恰尔医学院对21例确诊为梗阻性分娩的病例进行了该手术，并对原手术进行了一些小的改进。所有病例均采用皮下方法，这种方法美观且简单。手术在局部麻醉下进行，完全切断上韧带，部分切断前弓状韧带。后弓状韧带完全未触及。所有病例均无需使用产钳或真空吸引。与初次剖宫产的发病率和死亡率相比，该手术导致的并发症几乎可以忽略不计。考虑到该手术的实用性，如果妇科医生经过适当培训，能够在适当选择的病例中以合理的方式进行操作，甚至可以在农村医院开展该手术。
