Boyd M E
Department of Obstetrics and Gynecology, Royal Victoria Hospital, Montreal, PQ.
Can J Surg. 1988 Jan;31(1):10-3.
Cesarean section has become a common operation, but its complexity should not be underestimated. Often it must be done as an emergency without skilled assistants; at the same time the surgeon must deal with the maternal disorder that prompted the cesarean section and ensure the well-being of the fetus. Of further concern is the operative blood loss, which can be massive, and the postoperative morbidity, which is often high. The operative technique has evolved from an intraperitoneal vertical incision on the body of the uterus (classical cesarean section) to a near-complete reliance on a retroperitoneal transverse incision (lower segment cesarean section). The historic reason for this change was the fear of peritonitis postoperatively. Present-day practice favours the lower segment operation and emphasizes the reduced operative blood loss and the more secure uterine scar as reasons for the choice. Operative complications (injury to the fetus, lacerations of the uterus and vagina) are the result of inadequate uterine incisions. The classical incision has the advantage of being easily extended and thus has a continued purpose. Postoperative febrile morbidity is attributed to endometritis; the mixed aerobic and anaerobic bacteria of the vagina are the causal organisms. Febrile morbidity can be prevented by antibiotics given prophylactically.
剖宫产已成为一种常见手术，但其复杂性不容小觑。通常情况下，剖宫产必须在紧急情况下进行，且没有熟练的助手；与此同时，外科医生必须处理引发剖宫产的母体疾病，并确保胎儿的健康。更令人担忧的是手术出血量可能很大，以及术后发病率往往较高。手术技术已从子宫体部的腹膜内垂直切口（经典剖宫产）发展到几乎完全依赖腹膜后横切口（下段剖宫产）。这种变化的历史原因是担心术后发生腹膜炎。目前的做法倾向于下段手术，并强调减少手术出血量以及子宫瘢痕更安全是选择该术式的原因。手术并发症（胎儿损伤、子宫和阴道撕裂）是子宫切口不当的结果。经典切口具有易于延长的优点，因此仍有其用途。术后发热性疾病归因于子宫内膜炎；阴道内的需氧菌和厌氧菌混合是致病微生物。预防性使用抗生素可预防发热性疾病。
