Lyell Deirdre J, Power Michael, Murtough Katie, Ness Amen, Anderson Britta, Erickson Kristine, Schulkin Jay
Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California.
Research Department, American College of Obstetricians & Gynecologists, Washington, District of Columbia.
Surg J (N Y). 2016 Nov 14;2(4):e119-e125. doi: 10.1055/s-0036-1594247. eCollection 2016 Oct.
To assess the frequency of surgical techniques at cesarean delivery (CD) among U.S. obstetricians. Members of the American College of Obstetrician Gynecologists were randomly selected and e-mailed an online survey that assessed surgical closure techniques, demographics, and reasons. Data were analyzed using SPSS (IBM Corp., Armonk, New York, United States), descriptive statistics, and analysis of variance. Our response rate was 53%, and 247 surveys were analyzed. A similar number of respondents either "always or usually" versus "rarely or never" reapproximate the rectus muscles (38.4% versus 43.3%, = 0.39), and close parietal peritoneum (42.5% versus 46.9%, = 0.46). The most frequently used techniques were double-layer hysterotomy closure among women planning future children (73.3%) and suturing versus stapling skin (67.6%); the least frequent technique was closure of visceral peritoneum (12.2%). Surgeons who perform double-layer hysterotomy closure had fewer years in practice (15.0 versus 18.7 years, = 0.021); surgeons who close visceral peritoneum were older (55.5 versus 46.4 years old, < 0.001) and had more years in practice (23.8 versus 13.8 years practice; < 0.001). Similar numbers of obstetricians either reapproximate or leave open the rectus muscles and parietal peritoneum at CD, suggesting that wide variation in practice exists. Surgeon demographics and safety concerns play a role in some techniques.
评估美国产科医生剖宫产手术技术的使用频率。 随机选取美国妇产科医师学会成员，通过电子邮件向其发送一份在线调查问卷，该问卷评估手术缝合技术、人口统计学特征及原因。使用SPSS（美国纽约州阿蒙克市国际商业机器公司）对数据进行分析，采用描述性统计和方差分析。 我们的回复率为53%，共分析了247份调查问卷。相似数量的受访者“总是或通常”与“很少或从不”重新对合腹直肌（38.4%对43.3%，P = 0.39），以及关闭脏腹膜（42.5%对46.9%，P = 0.46）。最常用的技术是计划未来生育的女性采用双层子宫切口缝合（73.3%）以及皮肤缝合与钉合（67.6%）；最不常用的技术是关闭脏腹膜（12.2%）。进行双层子宫切口缝合的外科医生从业年限较少（15.0年对18.7年，P = 0.021）；关闭脏腹膜的外科医生年龄较大（55.5岁对46.4岁，P < 0.001）且从业年限更多（23.8年对13.8年，P < 0.001）。 相似数量的产科医生在剖宫产时重新对合或不缝合腹直肌及脏腹膜，这表明实际操作存在很大差异。外科医生的人口统计学特征和安全顾虑在某些技术中起作用。
