林凤英

[摘要] 目的 探讨腹壁横切口子宫下段剖宫产术对于腹部肌群的损伤情况。 方法 收集2012年1月—2014年1月，该院产科住院行子宫下段剖宫产术产妇600例，根据手术切口部位分组，380例经腹壁横切口术者为观察组，220例经腹壁纵切口术者为对照组，比较两组产后腹部肌群损伤情况。 结果 产后1周，观察组的腹部疼痛及皮下硬结率分别为80.0%、31.8%，显著高于对照组的5.0%、0.0%（P<0.05）；产后6周，观察组的腹部疼痛率为15.0%，仍显著高于对照组（P<0.05）；产后6周两组皮下硬结均消失；产后1周，观察组的腹壁肌肉损伤率及损伤程度显著高于对照组（P<0.05），且产后6周，观察组仍有44.2%残存损伤。 结论 腹壁横切口子宫下段剖宫产术对于产妇腹部肌群损伤率较高且损伤较为严重，具有一定的应用缺陷。

[关键词] 腹壁横切口；腹壁纵切口；子宫下段剖宫产术；腹部肌群损伤

[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742（2015）09（c）-0057-02

[Abstract] Objective To investigate the situation of abdominal muscle injury caused by lower uterine segment cesarean section through abdominal transverse incision. Methods 600 patients undergoing lower uterine segment cesarean section in the Department of Gynecology and Obstetrics in this hospital between January 2012 and 2014 January were collected and all were divided into two groups according to their surgical incision site， observation group （n=380， through abdominal transverse incision） and control group （n=220， through abdominal longitudinal incision）. The postnatal abdominal muscle injury situation of the two groups was compared. Results One week after postpartum， the abdominal pain rate and subcutaneous induration rate of observation group was 80.0% and 31.8%， which were obviously higher than the 5.0% and 0.0% of control group （P<0.05）； 6 weeks after postpartum， the observation groups abdominal pain rate was 15.0%， but still obvious higher than the control group（P<0.05）， the two groups subcutaneous induration disappeared at 6 weeks postpartum ； one week after postpartum， the observation groups abdominal muscle injury rate was obvious higher than the control group（P<0.05），and 6 weeks after postpartum， the observation group still had 44.2% residual damage. Conclusion Lower uterine segment cesarean section through abdominal transverse incision has higher injury rate and can cause more serious damage to abdominal muscle， therefore it has some defects in practical application.

[Key words] Abdominal transverse incision； Abdominal longitudinal incision； Lower uterine segment cesarean section； Abdominal muscle Injury

剖宫产手术是临床解决难产以及部分产科合并症的关键术式之一，且受社会因素、心理因素等多种因素的影响，剖宫产率呈现逐年上升趋势[1]。不同切口剖宫产术对于腹壁肌群损伤率及损伤程度不同，这也是影响患者的术后康复及再次剖宫产的重要因素。该研究比较分析了经腹壁横切口和经腹壁纵切口子宫下段剖宫产术对于产妇腹壁肌群的损伤，现分析2012年1月—2014年1月在该院产科住院行子宫下段剖宫产手术产妇600例的临床资料，现报道如下。

1 资料与方法

1.1 一般资料

收集该院产科行剖宫产术的孕妇600例为研究对象，均为单胎初产妇，根据手术切口部位分组，380例经腹壁横切口术者为观察组，220例经腹壁纵切口术者为对照组。观察组年龄22～38（25.4±2.5）岁；孕周37～42（39.1±0.8）周；体重64.2～73.6（66.9±1.3）kg。对照组年龄21～40（26.3±2.2）岁；孕周38～42（39.6±1.1）周；体重65.3～74.4（67.2±1.9）kg。

1.2 方法

观察组：该组行腹部横切口术式，连续硬模外麻醉后，常规消毒铺巾并暴露术野，于耻骨联合上方2 cm处行12～15 cm的弧形皮肤横切口，切口两段略弯向髂嵴方向。……