剖宫产术后不同时期子宫瘢痕愈合的临床观察及其与胶原表达水平的关系

Clinical Observation of Uterine Scar Healing in Different Period after Cesarean Section and the Relationship with the Level of Collagen Expression

目的探讨剖官产术后瘢痕子宫在不同时期的愈合变化过程，及其与胶原表达水平的关系。方法选取250例瘢痕子宫再次行剖宫产的产妇为研究组，另取10例初次剖宫产产妇为对照组。分别取子宫瘢痕组织与子宫下段正常组织行免疫组化染色、检测。根据剖宫产术中肉眼所见子宫瘢痕肌层的厚度分为子宫下段完整组（A组）、子宫下段变薄组（B组）和子宫下段破裂组（c组）。将产妇按照本次妊娠与上次剖宫产间隔时间分成6组，〈2年组，2—4年组，4—6吗：组，608年组，8～10年组和≥10年组。分析子宫瘢痕肌层愈合与剖宫产间隔时间的关系，观察子宫瘢痕肌层组织Ⅰ、Ⅲ型胶原在不同时期的表达，并将免疫组化染色结果根据着色程魔襁阳性细胞率进行评分。结果研究组2～4年组_发生子宫肌层菲薄率、破裂率低于〈2年组、4—6年组、6—8年组、8—10年组、≥10年组，差异有统计学意义（P〈0．001）。研究组2—4年组产妇子宫瘢痕肌层的Ⅰ、Ⅲ型胶原评分与对照组比较，差异没有统计学意义（P〉0．05），其他5个时期组与对照组相比较，差异均有统计学意义（P=0．000）。结论在2年内及4年以上再次妊娠会增加子宫破裂的概率，距上次剖宫产间隔时间2—4年是子宫瘢痕肌层修复愈合的最佳时间，此时Ⅰ、Ⅲ型胶原在子宫瘢痕肌层组织中的表达与正常子宫肌层组织表达相比差异无统计学意义，建议在此时间段内行二次妊娠，可以将二次妊娠风险降至最低。

Objective To study the healing process of scar uterus in different period after cesarean section, and its relationship with the level of expression of collagen. Methods Two hundred and fifty cases of uterine scar with cesarean section again were enrolled as the study group, while 10 cases of primary cesarean section as the control group. The uterus scar tissue and the lower uterine segment of normal tissue were taken and immunohistochemieal staining were detected. According to the muscle layer thickness of uterine scar, the complete lower uterine segment was subjected to group A, the thinning lower uterine segment was subjected to group B, the rupture lower uterine segment was subjected to C. According to the interval from the previous cesarean section, six groups were divided： 〈 2 years group, 2 -4 year group, 4 -6 year group, 6 - 8 year group,,8 - 10 year group, and ≥ 10 years group in order to study the relationship between uefine scar healing and cesarean interval. The Ⅰ, Ⅲ collagen expression in different periods were observed. According to the degree of col, oration, the immunohistochemical staining results and positive cells were scored. Results Myometrium meager rate, rupture rate in 2 -year group patients was less than 〈 2 years group, 4 - 6 year group, 6 - 8 year group, 8 - 10 years group, and ≥ 10 years group and, the difference was statistically significant （P 〈 0. 001 ）. The comparison between Ⅰ, Ⅲ collagen rating in uterus scar myometrium with 2 -4 year group and the control group showed that there were no statistically significant differences P 〉 0.05）. The comparison between five other periods group and the control group showed that the differences were statistical significant （P 〈 0. 001 ）. Conclusion The probabil- ity of uterus rupture will increase if pregnancy occurred again in 2 years or more than 4 years. From the last cesarean 2 - 4 years is the best time to repair the muscle of the uterus scar healing, at this time, Ⅰ , Ⅲ collagen expression in uterine myometrium scar tissue and normal myometrium were not statistically significant difference. If patients underwent secondary pregnancy during this period, the second pregnancy risks can be minimized.