剖宫产术后子宫切口愈合情况的B超与临床监测

The Monitoring of Post Cesarean Section Uterine Scal with B ultrasonographic and Clinical Detections

目的：监测剖宫产术后子宫切口的愈合情况。方法：采用Ｂ超、体温及血象系统监测了１１４５例剖宫产术后子宫切口的愈合情况，对部分子宫切口有积液的患者，于术后第８天在Ｂ超导向下经皮穿刺抽液，注入抗生素和小剂量皮质激素（穿刺组），并与同期住院但未作穿刺治疗的同类患者（对照组）进行比较。结果：根据声象图特点，将子宫切口愈合情况分为３类。Ⅰ类：子宫切口呈平行或弧状强回声光带，愈合良好（占９３．９７％）；Ⅱ类：子宫切口呈一实质性非均质性光团，为子宫切口炎性反应（占３．６７％）；Ⅲ类：子宫切口呈以低或无回声光团为主的混合性光团，为子宫切口炎性反应伴积液（占２．３６％）。Ⅱ、Ⅲ类子宫切口患者临床表现有不同程度的体温、血象及恶露异常，并以体温及血象异常较为突出。穿刺组子宫切口声象图恢复正常的时间，血性恶露持续时间，平均住院时间均明显短于对照组（Ｐ＜０．０５）；无一例发生晚期产后出血。结论：Ｂ超及临床监测剖宫产术后子宫切口的愈合情况，可为防治晚期产后出血提供一种有效的方法。

Objective: To find out an effective method for monitoring the healing of uterine incision after cesarean section. Methods: 1 145 patients with cesarean section were monitored by B ultrasonography. In 19 patients who revealed fluid mass in uterine incision, 10 cases were treated by percutaneous drainage under sonographic guidance and 9 cases as control. Results: Accoding to sonographic characteristics, uterine incision healing can be divided into three conditions: normal type revealing a smooth strong echo′s light band in uterine incision (93.97%), inflammatory type revealing an uneven parenchymatous light mass (3.67%), and fluid mass with inflammation revealing a complex light mass with low echo′s or anechoic area (2.36%). There were abnormal clinical signs in most cases of inflammation. The percutaneous drainage therapy showed marked effect. Conclusions: The monitoring of uterine incision healing by B ultrasonography plays an important role in preventing late post partum hemorrhage.