Bačić Boris, Hrgović Zlatko, Cerovac Anis, Barčot Ognjen, Sabljić Jelena, Markoski Blagoja, Leskur Mateo
Clinic of Obstetrics and Gynecology, Clinical Hospital Center, Split, Croatia.
University of Split, Medical School, Split, Croatia.
Z Geburtshilfe Neonatol. 2025 Jun;229(3):188-194. doi: 10.1055/a-2338-5802. Epub 2024 Jul 16.
The main advantage of extraperitoneal cesarean section (EXPCS) is not only less pain, faster recovery, and less potential for infection but also a possible lack of intraperitoneal adhesions.
In a 3-year period from 2019 to 2022, 88 EXPCSs were performed. A comparison was made with 90 patients who underwent a standard transperitoneal cesarean section (TPCS). For both groups, the inclusion criterion was uterine inertia and prolonged labor as an indication for cesarean section. Only pregnant women from 37 to 42 weeks were included. After this, 51 patients remained in the EXPCS arm, and 49 remained in the TPCS arm.
No statistical difference was found in gestational weeks, newborn weight, Apgar score, erythrocyte (Er), hemoglobin (Hgb), and hematocrit (Htc) values and duration of operative time between the EXPCS and TPCS groups. Leukocytes, C-reactive protein (CRP) with fever higher than >38°C on the third postoperative day were found statistically significantly (p=0.005) higher in the TPCS group. The usage of tramadol + metamizole at 3, 6, and 9 hours after delivery and diclofenac at 6, 12, and 18 hours after surgery was statistically significantly (p<0.05) higher in the TPCS group. On the visual analog scale (VAS) 24 hours after surgery, a statistically significant difference was found (p = 0.001) between the two groups. In the small group of patients who underwent a TPCS section after an EXPCS, intraperitoneal adhesions were not found; in another group of patients who underwent a TPCS twice, adhesions were found in 12 patients; Fisher's exact test (p=0.04).
The protective effect of EXPCS for infection could be proven in prolonged delivery. EXPCS could be a good solution in the fight against adhesions and infection in women who undergo second, third, or even fourth cesarean sections.
腹膜外剖宫产术（EXPCS）的主要优势不仅在于疼痛减轻、恢复更快、感染可能性降低，还可能在于缺乏腹腔内粘连。
在2019年至2022年的3年期间，共进行了88例腹膜外剖宫产术。将其与90例行标准经腹剖宫产术（TPCS）的患者进行比较。两组的纳入标准均为子宫收缩乏力和产程延长作为剖宫产指征。仅纳入孕周为37至42周的孕妇。此后，EXPCS组有51例患者，TPCS组有49例患者。
EXPCS组和TPCS组在孕周、新生儿体重、阿氏评分、红细胞（Er）、血红蛋白（Hgb）、血细胞比容（Htc）值以及手术时间方面均未发现统计学差异。术后第三天，TPCS组白细胞、C反应蛋白（CRP）以及体温高于38°C的发热情况在统计学上显著更高（p = 0.005）。TPCS组在产后3、6和9小时使用曲马多+安乃近以及术后6、12和18小时使用双氯芬酸的情况在统计学上显著更高（p < 0.05）。术后24小时采用视觉模拟评分法（VAS），两组之间存在统计学显著差异（p = 0.001）。在EXPCS术后行TPCS术的一小部分患者中，未发现腹腔内粘连；在另一组行两次TPCS术的患者中，12例发现有粘连；费舍尔精确检验（p = 0.04）。
在延长分娩中可证明EXPCS对感染有保护作用。对于接受第二次、第三次甚至第四次剖宫产的女性，EXPCS可能是对抗粘连和感染的良好解决方案。
