剖宫产术后发生盆腔粘连的相关因素分析

Analysis of Correlative Factors of Pelvic Adhesions after Cesarean Section

摘要: 目的：探讨剖宫产术后患者再次妊娠时出现盆腔粘连情况的相关高危因素及对再次剖宫产手术的影响。方法选择：选取2019年1月~2021年12月之间在青岛大学附属医院行子宫下段剖宫产术的患者资料进行回顾性分析。根据术中所见将其分为两组。术中见盆腔脏器有膜状粘连或致密粘连者定义为盆腔粘连组，共计133例；盆腔脏器无粘连者为正常组，共计778例。对两组患者肌层是否连续、是否有妊娠期高血压疾病、是否有妊娠期糖尿病、两次剖宫产时间间隔、宫腔操作次数、首次术后发热、新生儿体质量、剖宫产次数、年龄、首次手术宫口开大情况、再次手术出血量、再次手术时间等数据利用SPSS26.0进行数据分析。结果：此911例患者未发生盆腔粘连患者778例，发生盆腔粘连患者133例，778例无盆腔粘连患者中妊娠高血压者60例、剖宫产次数大于2次者72例、年龄大于35岁者233例；133例有盆腔粘连患者中妊娠高血压者20例、剖宫产次数大于2次者25例、年龄大于35岁者50例，差别有统计学意义(P分别为0.006、0.001、0.038、0.004)。未发生盆腔粘连的778例患者中再次手术时间大于40分钟者578例，发生盆腔粘连的133例患者中手术时间大于40分钟者114例，差别有统计学意义(P为0.004)。结论：妊娠相关高血压患者、剖宫产次数大于2次、年龄大于35岁者易发生盆腔粘连，且出现盆腔粘连后再次手术时间较普通剖宫产时间长。

Abstract: Objective: To investigate the high risk factors of pelvic adhesions in patients with second pregnancy after cesarean section and their influence. Methods Selection: The data of patients who underwent lower segment cesarean section in the Affiliated Hospital of Qingdao University from January 2019 to December 2021 were retrospectively analyzed. They were divided into two groups according to the intraoperative findings. Pelvic organs with membranous or dense adhesions were defined as pelvic adhesions group (133 cases in total); there were 778 normal cases without pelvic organ ad-hesion. SPSS26.0 was used to analyze the data of the two groups of patients on whether the muscu-lar layer was continuous, whether they had hypertensive disorder complicating pregnancy, whether they had diabetes complicating pregnancy, the interval between two cesarean sections, the number of uterine cavity operations, whether they had fever after the first operation, the body mass of the newborn, the number of cesarean sections, age, the opening of the uterine orifice during the first operation, the amount of bleeding during the second operation, and the time of the second opera-tion. Results: Of the 911 patients, 778 had no pelvic adhesions, 133 had pelvic adhesions. Among the 778 patients without pelvic adhesions, 60 had pregnancy induced hypertension, 72 had cesar-ean section more than twice, and 233 were older than 35 years; Among the 133 patients with pelvic adhesions, 20 had pregnancy induced hypertension, 25 had cesarean section more than twice, and 50 were older than 35 years old. The differences were statistically significant (P = 0.006, 0.001, 0.038, 0.004). Among 778 patients without pelvic adhesions, 578 patients underwent reoperation for more than 40 minutes, and among 133 patients with pelvic adhesions, 114 patients underwent reoperation for more than 40 minutes, the difference was statistically significant (P = 0.004). Con-clusion: Patients with pregnancy related hypertension, those with more than two caesarean sec-tions and those over 35 years old are prone to pelvic adhesions, and the reoperation time after pel-vic adhesions is longer than that of ordinary caesarean sections.