Shand Antonia W, Chen Jian Sheng, Schnitzler Margaret, Roberts Christine L
Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, NSW, Australia; Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia.
Aust N Z J Obstet Gynaecol. 2015 Apr;55(2):170-5. doi: 10.1111/ajo.12270. Epub 2014 Nov 28.
Incisional hernias occur at surgical abdominal incision sites, but the association with caesarean section (CS) has not been examined.
To determine whether CS is a risk factor for incisional hernia repair.
Population-based cohort study in Australia using linked birth and hospital data for women who gave birth from 2000 to 2011. Survival analysis was used to explore the association between CS and subsequent incisional hernia repair. Analyses were adjusted for confounding factors, including other abdominal surgery. The main outcome measure was surgical repair of an incisional hernia.
Of 642,578 women, 217,555 (33.9%) had at least one CS and 1,554 (0.2%) women had a subsequent incisional hernia repair. The rate of incisional hernia repair in women who had ever had a caesarean section was 0.47%, compared to 0.12% in women who never had a caesarean section. After controlling for the duration of follow-up and known explanatory variables (eg other abdominal surgery, parity and multiple pregnancy), the adjusted hazard ratio (aHR) was 2.73 (95% confidence interval (CI) 2.45-3.06, P < 0.001). Incisional hernia repair risk increased with number of caesarean sections: women with two CS had a threefold increased risk of incisional hernia repair, which increased to sixfold after five CS (aHR = 6.29, 95% CI 3.99-9.93, P < 0.001) compared to women with no CS.
There was a strong association between maternal CS and subsequent incisional hernia repair, which increased as the number of CSs increased, but the absolute risk of incisional hernia repair was low.
切口疝发生于腹部手术切口部位，但剖宫产与切口疝的关联尚未得到研究。
确定剖宫产是否为切口疝修补术的危险因素。
在澳大利亚开展基于人群的队列研究，使用2000年至2011年分娩女性的出生与医院数据链接。采用生存分析探讨剖宫产与后续切口疝修补术之间的关联。分析对包括其他腹部手术在内的混杂因素进行了校正。主要结局指标为切口疝的手术修补。
在642,578名女性中，217,555名（33.9%）至少进行过一次剖宫产，1,554名（0.2%）女性随后接受了切口疝修补术。曾行剖宫产的女性切口疝修补率为0.47%，而从未行剖宫产的女性为0.12%。在控制随访时间和已知解释变量（如其他腹部手术、产次和多胎妊娠）后，校正风险比（aHR）为2.73（95%置信区间（CI）2.45 - 3.06，P < 0.001）。切口疝修补风险随剖宫产次数增加而升高：与未行剖宫产的女性相比，行两次剖宫产的女性切口疝修补风险增加两倍，行五次剖宫产的女性风险增至六倍（aHR = 6.29，95% CI 3.99 - 9.93，P < 0.001）。
母亲剖宫产与后续切口疝修补术之间存在密切关联，且随着剖宫产次数增加而增强，但切口疝修补的绝对风险较低。
