Habek Dubravko, Cerovac Anis, Luetić Ana, Marton Ingrid, Prka Matija, Kulaš Tomislav, Ujević Boris
University Department of Gynecology and Obstetrics, Clinical Hospital, Sveti Duh "Zagreb, Croatian Catholic University Zagreb, Croatia.
Department of Gynecology and Obstetrics, General Hospital Tešanj, Bosnia and Herzegovina.
Eur J Obstet Gynecol Reprod Biol. 2020 Apr;247:90-93. doi: 10.1016/j.ejogrb.2020.02.026. Epub 2020 Feb 14.
A 15-year-experience of the personal modification of Misgav Ladach (ML) caesarean section in relation to the Dörffler method.
A retrospective clinical randomized observational study included 822 transperitoneal cesarean sections: 557 were performed via modified ML (without bladder catheterization, small transverse fascial incision with muscular stretching and non-preparation of vesicouterine plica) vs. 265 Dörffler (Pfannenstiel - Kerr) method.
Perioperative and postoperative complications were significantly more frequent in the Dörffler method (p < 0.0005) (perioperative hemorrhage, more frequent adhesions, plastic peritonitis in repeated caesarean sections, as well as two bladder lesions). Postoperative febrility, dehiscence and wound seroma were more frequent in the first study group (p < 0.0005). More frequent paralytic ileus, uroinfections and bladder atony, which we did not observe in our own technique (p < 0.0005). The use of antibiotics and analgesics was prolonged until the fifth postoperative day in the first group compared to the second group where it was reduced to only 10 % on the second day (p < 0.0005). Also, the incidence of anemia and the need for blood transfusions were higher in the first study group, as well as the need for revision behind caesarean section and two hysterectomies due to massive postoperative intraperitoneal and retroperitoneal bleeding (p < 0.0005).
Our fifteen-year study highlighted the importance of our own published modified ML caesarean section in minimizing technique of surgery and the reduction of perioperative morbidity and significantly faster recovery of operated patients in the current era of enormous caesarean section increase.
对比米斯加夫-拉达赫（ML）剖宫产术个人改良法与多弗勒法的15年经验。
一项回顾性临床随机观察性研究纳入了822例经腹剖宫产术：557例采用改良ML法（不插膀胱导尿管，小横筋膜切口、肌肉拉伸且不处理膀胱子宫襞），265例采用多弗勒（Pfannenstiel - Kerr）法。
多弗勒法的围手术期和术后并发症明显更常见（p < 0.0005）（围手术期出血、粘连更常见，再次剖宫产时发生化脓性腹膜炎，以及两例膀胱损伤）。术后发热、切口裂开和伤口血清肿在第一研究组更常见（p < 0.0005）。麻痹性肠梗阻、尿路感染和膀胱无张力更常见，而在我们自己的技术中未观察到（p < 0.0005）。与第二组相比，第一组抗生素和镇痛药的使用延长至术后第5天，而第二组在术后第2天仅10%的患者仍在使用（p < 0.0005）。此外，第一研究组贫血发生率、输血需求、剖宫产术后再次手术需求以及因术后大量腹腔内和腹膜后出血行子宫切除术的需求也更高（p < 0.0005）。
我们的15年研究突出了我们已发表的改良ML剖宫产术在简化手术技术、降低围手术期发病率以及在当前剖宫产率大幅上升的时代使手术患者恢复明显加快方面的重要性。
