AbstractCesarean section (CS) is the commonest major operation carried out in many low income countries. A new technique for CS, called the Misgav Ladach procedure, was evaluated in a randomized trial in Nazareth Hospital (Kiambu District, Kenya). A total of 160 patients were assigned to the Misgav Ladach procedure (n=80) or to the traditional CS as performed in most rural hospitals in low income countries (n=80). The two groups were analyzed by operating time, presence of infection and febrile morbidity, grade of postoperative pain, starting of fluid and solid alimentation, and development of incisional hernia and hypertrophic scar. The operating time of the Misgav Ladach procedure was significantly shorter. 20.4 (SD 6.1) minutes versus 30.4 (SD 6.1) minutes (p< 0.001). A total of 5 wound infections (6.2%) were seen with the Misgav Ladach procedure versus 16 (20.0%) in the control group (p=0.01). The number of analgesic doses required during the postoperative period were significantly less in the Misgav Ladach group: 1.3 (SD 0.6) versus 1.9 (SD 0.7) ampuls of pethidine (p<0.001) and 15.1 (SD 2.0) versus 16.4 (SD 1.8) tablets of ibuprofen (p<0.001). Incisional pain was significantly less in the Misgav Ladach group: Visual Analogue Scale score 3.0 (SD 1.5) versus 4.9 (SD 2.0),p<0.01. The patients in the Misgav Ladach group began drinking fluids voluntarily [19.1 (SD 4.5) hours versus 20.6 (SD 4.0) hours;p=0.01] and eating solid food [41.2 (SD 9.3) hours versus 46.1 (SD 9.0) hours;p<0.01] significantly before than those in the control group. At the 6‐week follow‐up, the presence of hypertrophic scar was significantly associated with the traditional procedure (2.1% vs. 48.8%;p<0.001). We conclude that the Misgav Ladach operation should become the standard method for performing CS in low income countries, particularly in rural hospitals.
摘要剖腹产(CS)是许多低收入国家最常见的大型手术。肯尼亚基安布地区的拿撒勒医院进行了一项随机试验,对一种名为 Misgav Ladach 的新剖腹产技术进行了评估。共有 160 名患者被分配接受 Misgav Ladach 手术(80 人)或低收入国家大多数农村医院的传统 CS(80 人)。根据手术时间、感染和发热发病率、术后疼痛程度、开始进食液体和固体食物以及切口疝和增生性疤痕的发展情况对两组患者进行了分析。Misgav Ladach手术的手术时间明显更短。20.4(标准差 6.1)分钟对 30.4(标准差 6.1)分钟(p< 0.001)。Misgav Ladach 手术共出现 5 例伤口感染(6.2%),而对照组为 16 例(20.0%)(P=0.01)。Misgav Ladach 组术后所需的镇痛剂量明显减少:哌替啶 1.3 安瓿 (SD 0.6) 对对照组 1.9 安瓿 (SD 0.7) (p<0.001),布洛芬 15.1 片 (SD 2.0) 对对照组 16.4 片 (SD 1.8) (p<0.001)。Misgav Ladach 组的切口疼痛明显减轻:视觉模拟量表评分 3.0 (SD 1.5) 对 4.9 (SD 2.0),p<0.01。与对照组相比,Misgav Ladach 组患者开始主动饮水[19.1 (SD 4.5) 小时对 20.6 (SD 4.0) 小时;p=0.01]和进食固体食物[41.2 (SD 9.3) 小时对 46.1 (SD 9.0) 小时;p<0.01]的时间明显提前。在 6 周的随访中,增生性疤痕的出现与传统手术有显著相关性(2.1% 对 48.8%;p<0.001)。我们的结论是,Misgav Ladach 手术应成为低收入国家,尤其是农村医院实施 CS 的标准方法。