Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 10833 Le Conte Avenue, Room 27-139 CHS, Los Angeles, CA, 90095-1740, USA.
BMC Pregnancy Childbirth. 2020 Jan 31;20(1):65. doi: 10.1186/s12884-020-2768-7.
To investigate differences in perioperative outcomes by type of skin incision, transverse versus vertical, for planned cesarean hysterectomy for placenta accreta spectrum (PAS).
A retrospective cohort study of all women who underwent a planned cesarean hysterectomy for abnormal placentation at a single academic medical center over 5 years. The Student's t-test was used for continuous variables and Fisher's exact test compared categorical variables. Continuous data were presented as median and compared using the Wilcoxon-rank sum test.
Forty-two planned cesarean hysterectomies were identified. A transverse skin incision was made in 43% (n = 18); a vertical skin incision was made in 57% (n = 24). Skin incision was independent of BMI (30.3 vs 30.8 kg/m, p = 0.37), placental location (p = 0.82), and PAS-subtype (p = 0.26). Mean estimated blood loss (EBL) was 2.73 l (L) (range 0.5-20) and was not significantly different between transverse and vertical skin incision (2.6 L vs 2.8 L, p = 0.8). There was significantly shorter operative time with transverse skin incision (180 vs 238 min, p = 0.03), with no difference in intraoperative complications, including cystotomy (p = 0.22) and ureteral injury (p = 0.73). Postoperatively, there was no difference in maternal length of stay (4.8 vs 4.4 days, p = 0.74) or post-operative opioid use (117 vs 180 morphine equivalents, p = 0.31).
Transverse skin incision is associated with shorter operative time for patients undergoing planned cesarean hysterectomy. There was no difference in EBL, intraoperative complications, postoperative length of stay, or opioid use. Given an increasing rate of cesarean hysterectomy, we should consider variables that optimize maternal outcomes and resource utilization.
为了研究胎盘植入谱系（PAS）计划剖宫产子宫切除术中横切口与纵切口的围手术期结局差异。
这是一项回顾性队列研究，纳入了在一家学术医疗中心接受计划剖宫产子宫切除术的所有因异常胎盘植入的患者，研究时间为 5 年。使用学生 t 检验比较连续变量，使用 Fisher 确切检验比较分类变量。连续数据以中位数表示，并使用 Wilcoxon 秩和检验进行比较。
共确定了 42 例计划剖宫产子宫切除术。横切口占 43%（n=18），纵切口占 57%（n=24）。切口类型与 BMI（30.3 与 30.8kg/m，p=0.37）、胎盘位置（p=0.82）和 PAS 亚型（p=0.26）无关。估计失血量（EBL）均值为 2.73L（范围 0.5-20），横切口与纵切口之间无显著差异（2.6L 与 2.8L，p=0.8）。横切口手术时间明显缩短（180 分钟与 238 分钟，p=0.03），术中并发症（包括膀胱切开术，p=0.22 和输尿管损伤，p=0.73）无差异。术后，母亲的住院时间（4.8 天与 4.4 天，p=0.74）和术后阿片类药物使用量（117 毫克吗啡当量与 180 毫克吗啡当量，p=0.31）无差异。
对于接受计划剖宫产子宫切除术的患者，横切口与较短的手术时间相关。EBL、术中并发症、术后住院时间或阿片类药物使用无差异。鉴于剖宫产子宫切除术的发生率不断增加，我们应该考虑优化母婴结局和资源利用的变量。
