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Objective: to analyze the effect and significance of surgical incision layer protector on the operation process and prognosis during cesarean section.
Methods: 200 cases of cesarean section were selected and compared with the traditional operation in terms of operation time, amount of bleeding, puerperal disease rate, incision healing and incidence of endometriosis.
Results: the above indexes in the observation group were significantly better than those in the control group. The method was simple and easy. The ring diameter of the incision protector should be 15 ~ 18cm.
Conclusion: the use of surgical incision layer protector in cesarean section can significantly improve the quality of cesarean section, which is worthy of popularization.
Cesarean section is a routine obstetric operation. In recent years, the rate of cesarean section has been increasing. The cesarean section rate in some medical institutions is as high as 80%. With the increase of cesarean section rate. Complications after cesarean section also increased. Effective prevention and treatment of complications after cesarean section is a subject of continuous exploration in obstetrics. 3L surgical incision protective sleeve was used in cesarean section in our hospital, and satisfactory results were achieved. It is introduced as follows.
1、 Data and methods:
1. General data: 450 pregnant women undergoing cesarean section were divided into two groups. Observation group: 200 cases used 3L surgical incision protective sleeve during cesarean section. Control group: 250 cases without incision protector during cesarean section in our hospital. There were 35 cases of cesarean section in the observation group and 43 cases in the control group. There were no serious obstetric complications between the two groups, and there was no significant difference in age, gestational age and weight (P > 0.05).
2. Methods: observation group: after opening the peritoneal cavity during cesarean section (both the lower abdominal suprapubic transverse incision and the umbilical midline incision), wet and lubricate the central ring of 3L surgical incision protector (both medium and small), slide it into the abdominal cavity, spread out the film to protect the operation field, and continue to complete the operation according to the conventional steps. When the fetus and placenta are delivered, clean the uterine cavity, suture the myometrium and serosa, After washing the abdominal cavity of the basin, take out the protective sleeve of the surgical incision, continue to suture all layers of the peritoneum and abdominal wall, and complete the operation. Control group: the operation was completed according to the operation procedure of lower uterine cesarean section.
3. OUTCOME MEASURES: for the two groups, the following indexes were observed: operation time, amount of bleeding, puerperal disease rate, incision healing and the incidence of incision endometriosis.
4. Statistical treatment: the operation time and bleeding volume were statistically analyzed by t-test. For the puerperal disease rate, incision healing and the incidence of incision endometriosis, the relative risk was analyzed because there were few cases.
2、 Results:
The operation time in the observation group was 25 ~ 50 minutes, with an average of 31.4 ± 4.6 minutes, and that in the control group was 35 ~ 7 o minutes, with an average of 45.7 ± 5.1 minutes. There was significant difference between the two groups (P < 0.01). The amount of bleeding in the observation group was 100 ~ 400ml, with an average of 140.3 ± 8.5ml, and that in the control group was 100 ~ 500ml, with an average of 148.1 ± 10.3ml. There was no significant difference between the two groups (P > 0.05). Puerperal disease rate: there were 12 cases (6.0%) of postoperative fever in the observation group, mainly low fever, the body temperature was basically below 38 ℃, only 2 cases had fever for more than 3 days, 43 cases (17.2%) in the control group, 1 / 3 of the cases had fever, the body temperature was more than 38 ℃, 18 cases had fever for more than 3 days, the relative risk of the control group was 3.25 times that of the observation group, and the relative risk of severe fever was 3.6 times that of the observation group. Wound healing: there were 1 case (0.5%) of surgical incision fat liquefaction in the observation group and 5 cases (2.0%) in the control group. The relative risk in the control group was 4.06 times higher than that in the observation group. The incidence of incision endometriosis was not observed in the observation group and 3 cases (1.2%) in the control group.
3、 Discussion: there was no significant difference in surgical blood loss between the two groups, because the blood loss during cesarean section was mainly due to placental detachment and uterine cavity. The observation group was significantly better than the control group in operation time, puerperal disease rate, surgical incision healing and the incidence of surgical incision endometriosis. In the observation group, the use of surgical incision protector during cesarean section can effectively protect the pollution and planting of pregnant uterine contents (including amniotic fluid, fetal fat, meconium, uterine blood and endometrium) to the surgical incision, and can effectively eliminate the occurrence of abdominal incision endometriosis after cesarean section. Especially in small month cesarean section, endometrial implantation is more likely to cause incision endometriosis, so effective intraoperative protection is particularly important. We found that in the control group, due to the impregnation of the contents of the pregnancy Palace on the surgical incision, it must take some time to clean the incision wound and stop bleeding. In fact, most of the "bleeding points" are not caused by real bleeding. Too many ineffective operations not only significantly increase the operation time. It also brings hidden dangers for postoperative incision infection and incision fat liquefaction. The relative risk of the above indexes in the control group was 3 ~ 4 times higher than that in the observation group. The surgical incision protective sleeve can also effectively prevent the infiltration of intraoperative amniotic fluid and flushing fluid on cotton surgical dressing, keep the surgical area dry, comply with the principle of sterility, and further reduce the risk of incision infection. Due to the reduction of puerperal disease rate, the use of antibiotics in the observation group was significantly better than that in the control group in terms of quality, quantity and use time. 3L surgical incision protective sleeve has low price and low expenditure. This method is conducive to postoperative recovery, reduce the use of postoperative antibiotics, reduce the expenditure, and prevent other disadvantages caused by excessive use of antibiotics. The social and economic benefits are obvious. Through practice, we believe that the ring diameter of incision protective sleeve should be 15 ~ 18cm, which can not only facilitate the removal and placement during operation, but also make the inner ring of protector better fit the peritoneal surface, and the protective effect on the incision is more obvious. It is suggested that the manufacturer organize the production of special incision protective sleeve for cesarean section.