| 摘要: |
| 目的:比较二次剖宫产术中原子宫切口瘢痕切除与否对剖宫产切口瘢痕憩室(PCSD)形成的影响,为临床PCSD的预防提供依据。方法:选取择期二次剖宫产的产妇共360例,其中采用先行原子宫切口瘢痕切除,再双层连续缝合子宫的产妇为研究组,直接行双层连续缝合子宫的产妇为对照组。统计两组手术时间、术中出血量、术后血性恶露持续时间、肛门排气时间、住院天数。术后6月至1年进行随访,评估是否出现异常阴道流血,并在术后1年应用阴道三维超声评估子宫切口愈合情况,分别统计两组产妇形成PCSD的例数,憩室残余子宫肌层厚度及憩室的大小。结果:两组的手术时间、术中出血量、术后血性恶露持续时间、肛门排气时间、住院天数差异均无统计学意义(P>0.05);研究组与对照组形成PCSD的例数分别为4例(2.2%)、15例(8.3%);憩室残余子宫肌层厚度均值分别为7.35±1.89 mm、4.98±2.03 mm;憩室容积分别为0.36±0.17 ml、0.53±0.13 ml(P<0.01)。结论:二次剖宫产术中切除原子宫切口瘢痕更利于切口愈合,减少PCSD的形成,减轻所形成的PCSD的程度。 |
| 关键词: 二次剖宫产 剖宫产切口瘢痕憩室 瘢痕切除 切口愈合 |
| DOI： |
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| 基金项目: |
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| The Clinical Study on the Prevention of Cesarean Scar Diverticulum by Previous Uterine Scar Excision during the Second Cesarean Section |
| SHEN Kewei;ZHANG Yingzhi;ZHOU Huanzhen |
| (The Affiliated Hospital of Ningbo University) |
| Abstract: |
| Objective: To compare the correlation between the excision of previous uterine scar during the second cesarean section and the formation of cesarean scar diverticulum,and to provide the basis for clinical prevention of cesarean scar diverticulum.Methods: 360 cases of multipara women who underwent the second cesarean section were included in this study.In the experimental group,the previous uterine cesarean scar of the patients were removed,and then the uterine incision was closed by double-layer continuous suture.In the control group,the uterine incision was directly closed by double-layer continuous suture without any treatment to the previous scar.The operation time,intraoperative blood loss,the duration of postoperation bloody lochia,evacuation time and hospitalization time of those two groups were recorded and statistic analyzed.The follow-up visiting will last from six months to one year after the operation,to evaluate the symptom of abnormal vaginal bleeding,the recovery condition of uterine incision will be estimated by three-dimensional transvaginal ultrasound examination in all patients one year postoperation. The cases of cesarean scar diverticulum,the thickness of remnant mesometrium,and the size of diverticulum were statistic analyzed in those two groups.Results: There was no statistical difference between experimental and control groups in operation time,intraoperative blood loss,the duration of postoperation bloody lochia,evacuation time and hospitalization time( P>0. 05).There were 4 patients( 2. 2% of all) had ultrasonographically visible cesarean scar diverticulum in experimental group,and 15 patients( 8. 3% of all) in the control group.The average thickness of remnant diverticulum mesometrium were 7. 35 ± 1. 89 mm in the experimental group and 4. 98 ±2. 03 mm in the control group,respectively.The volume of diverticulum were 0. 36 ± 0. 17 ml in experimental group and 0. 53 ± 0. 13 ml in control group( P<0. 01),respectively. Conclusions: Excision of previous uterine scar during the second cesarean section is more beneficial for uterine section healing,it will reduce the frequency of cesarean scar diverticulum formation,and alleviate the severity of cesarean scar diverticulum. |
| Key words: Secondarycesareansection Previouscesareanscardiverticulum Excisionscar Sectionhealing |
