剖宫产术中不同缝合方法与子宫瘢痕憩室的关系探析

Analysis of the relationship between different suture methods incesarean section and previous cesarean scar defect

目的:探析剖宫产术中不同缝合方法与子宫瘢痕憩室(PCSD)的关系。方法:选取我院2014年3月至2016年3月择期行剖宫产产妇186例,随机分为A、B两组,各93例。A组剖宫产术中采用单层缝合法,B组采用双层缝合法。两组患者出院后随访2年,至2018年3月所有随访完成。比较两组手术时间、术中出血量、肛门排气时间、住院时间、术后恶露持续时间、月经不调情况、切口愈合不良及PCSD发生率、PCSD肌层厚度、PCSD容积。结果:手术时间A组短于B组(P <0. 05),术中出血量、肛门排气时间、住院时间、术后恶露持续时间、月经不调发生率两组无明显差异(P> 0. 05),切口愈合不良发生率A组(12. 90%)高于B组(3. 32%)(P <0. 05),PCSD发生率A组(13. 98%)高于B组(5. 38%)(P <0. 05),PCSD肌层厚度A组比B组薄(P <0. 05),PCSD容积A组比B组大(P <0. 05)。结论:双层缝合是一种安全高效的缝合方式,与单层缝合相比可减少切口愈合不良及PCSD的发生,降低PCSD的危害。

Objective:To explore the relationship between different suture methods in cesarean section and previous cesarean scar defect (PCSD).Methods:186 puerperae who underwent elective cesarean section in the hospital from March 2014 to March 2016 were divided into group A and group B by the random number table method,with 93 cases in each group.Single-layer suture method was used in group A in cesarean section while double-layer suture method was used in group B.Both groups were followed up for 2 years after discharge till March 2018.The operation time,intraoperative blood loss,anal exhaust time,the length of hospital,duration of postoperative lochia,irregular menstruation,poor wound healing,the incidence,muscle thickness and volume of PCSD were compared between the two groups.Results:The operation time of group A was shorter than that of group B (P<0.05).There was no significant difference in intraoperative blood loss,anal exhaust time,the length of hospital stay,duration of postoperative lochia or the incidence of irregular menstruation (P>0.05).The incidence of poor wound healing was higher in group A (12.90%) than in group B (3.32%)(P<0.05).The incidence of PCSD was higher in group A (13.98%) than in group B (5.38%)(P<0.05 ).The muscle layer thickness of PCSD was thinner in group A than in group B (P<0.05),and volume of PCSD in group A was larger than that in group B (P<0.05).Conclusion:Double-layer suture is a safe and efficient suture method.Compared with single-layer suture,it can reduce the poor healing of the incision and the occurrence of PCSD,and reduce the harm of PCSD.