经阴道超声观察剖宫产术后瘢痕憩室的结构特点及其危险因素分析

Transvaginal Ultrasonic Observation of Structural Characteristics of Previous Cesarean Uterine Niches and Analysis of Its Risk Factors

目的经阴道超声观察剖宫产术后子宫瘢痕憩室的形态特征,分析其危险因素。方法选择2013年9月至2015年4月在华北理工大学附属医院行剖宫产且产后40~45 d在我院行经阴道超声检查的产妇128例。其中,瘢痕憩室组44例,瘢痕愈合良好组84例,观察瘢痕憩室的结构特点并分析其形成的危险因素。结果瘢痕憩室超声表现及特点：子宫切口处残余肌层变薄,肌层部分连续或完全不连续,但浆膜层仍完整;肌层缺损呈无回声或低无回声,与宫腔相通;瘢痕憩室形态多为三角形或楔形。logistic回归分析结果显示：子宫后位、产后感染及切口临近宫颈内口是瘢痕憩室形成的危险因素。结论经阴道超声检查能清晰观察并诊断子宫瘢痕憩室,为临床诊疗提供可靠的影像学依据,对避免或减少瘢痕憩室的发生具有重要临床价值。

Objective To observe the previous cesarean uterine niches with transvaginal sonography, and analyze the associated risk factors. Methods Totally 128 wonaen who received cesarean section in North China University of Science and Technology Affiliated Hospital between September 2013 and April 2015 were examined by transvaginal sonography 40 to 50 days after operation. Uterine niches were found in 44 cases, while the other 84 cases showed healed scar. The morphological features of previous cesarean scar defects were described, and the risk factors were analyzed. Resuits The chorion is complete, while the remaining myometrial thickness become thinner, and the myometrium is discontinuous. The defect is anechoic or hypoechoic area, which is connected with uterine cavity. The most commonly shapes are triangular and wedge. Logistic regression analysis shows that retroflexed uterus, the lower location of the incision, postcaesarean infection are the major risk factors. Conclusion The risk factors of uterine niches are retroflexed uterus, the lower location of the incision, and postcaesarean infection. Transvaginal sonography can clearly observed the niches, which not only provide reliable imaging basis for clinical diagnosis and treatment, but also plays an important role in avoiding or reducing the occurrence of niches.