摘要
目的探讨再次剖宫产时切除原子宫瘢痕对剖宫产术后瘢痕憩室（PCSD）形成的预防意义。方法选择2012年1月至2017年1月再次（二次）接受剖宫产的178例患者，随机数字表法分为对照组（术毕子宫切口直接给予双层连续缝合）与观察组（术毕先切除原切口的瘢痕组织、再行双层连续缝合），每组89例。对两组手术相关指标进行统计处理，均随访1年，记录两组阴道异常流血、PCSD、憩室残余的肌层厚度及憩室体积等情况。结果与对照组比较，观察组手术时间、出血量、首次排气时间、术后恶露时间及住院时间比较差异无统计学意义（P 〉 0.05）；但观察组阴道异常流血发生率、PCSD发生率明显降低[5.6%（5/89）比14.6%（13/89）、3.4%（3/89）比12.4%（11/89）]，憩室残余的肌层厚度增大[（7.36 ± 1.66）mm比（4.86 ± 1.38）mm]、憩室容积缩小[（0.37 ± 0.16）ml比（0.54 ± 0.15）ml]，差异有统计学意义（P 〈 0.05）。结论针对再次接受剖宫产孕妇在术中同时切除原子宫瘢痕对子宫切口的愈合更有利，除了降低形成PCSD概率的同时PCSD程度也得到减轻。
Objective To investigate the significance of previous uterine scar excision during the second cesarean section on prevention of previous cesarean scar diverticulum （PCSD）. Methods One hundred and seventy-eight cases of multipara women who underwent the second cesarean section were included from January 2012 to January 2017. And they were divided into the control group and the observation group by random digital table, with 89 cases in each group. In the control group, the uterine incision was directly closed by double-layer continuous suture without any treatment to the previous scar, and in the observation group, the previous uterine cesarean scar of the patients were removed, and then the uterine incision was closed by double-layer continuous suture. The surgical related indexes of the two groups were recorded and statistically analyzed. All patients were followed up for 1 year, and the abnormal vaginal bleeding, PCSD, the residual musculocutaneous thickness of diverticulum and the volume of diverticulum were statistically analyzed in those two groups. Results There were no statistical difference between observation group and control group in operation time, intraoperative blood loss, evacuation time, the duration of postoperation bloody lochia and hospitalization time （P 〉 0.05）. However, the abnormal vaginal bleeding [5.6%（5/89） vs. 14.6%（13/89）], the incidence of PCSD： 3.4% （3/89） vs. 12.4% （11/89）, and the residual musculocutaneous thickness of diverticulum： （7.36 ± 1.66） mm vs. （4.86 ± 1.38） mm, and the volume of diverticulum： （0.37 ± 0.16） ml vs. （0.54±0.15） ml in the observation group were decreased respectively, the differences were statistically significant （P 〈 0.05）. Conclusions Excision of previous uterine scar during the second cesarean section is more beneficial for uterine section healing. It will reduce the frequency of PCSD formation, and alleviate the severity of PCSD.
作者
邱伟
吴土连
黄艳
Qiu Wei;Wu Tulian;Huang Yan.(Department of Obstetrics and Gynecology, Gaozhou Traditional Chinese Medicine Hospital, Guangdong Gaozhou 525200, Chin)
出处
《中国医师进修杂志》
2018年第6期524-527,共4页
Chinese Journal of Postgraduates of Medicine
关键词
剖宫产术
再
瘢痕
憩室
瘢痕切除术
切口愈合
Cesarean section
repeat
Cicatrix
Diverticulum
Excision scar
Section healing
作者简介
通信作者：邱伟，Emai｜：tige78@126．com
