剖宫产子宫切口瘢痕憩室术后憩室再形成的影响因素分析

Influencing factors of diverticular regeneration after cicatricial diverticulum of caesarean section uterine incision

目的探讨剖宫产子宫切口瘢痕憩室术后憩室再形成的影响因素,为采取有效预防与控制措施提供依据。方法收集2016年1月—2017年1月宁波市妇女儿童医院收治的186例确诊为剖宫产子宫切口瘢痕憩室并行经阴式手术治疗的患者临床资料,将其按照术后愈合情况分为无憩室组(96例)和憩室再形成组(90例),并采用logistic回归分析探讨术后憩室再形成相关影响因素。结果本研究186例剖宫产子宫切口瘢痕憩室术后患者,憩室再形成患者90例,剖宫产子宫切口瘢痕憩室术后憩室再形成发生率为48.39%;憩室再形成组的术后阴道异常流血时间明显长于无憩室组,且憩室再形成组的术后阴道异常流血缩短时间明显短于无憩室组(均P<0.05)。单因素分析发现剖宫产子宫切口瘢痕憩室术后憩室再形成与术前阴道流血时间、手术距离上次剖宫产时间、术后血红蛋白值等因素相关(均P<0.05)。多因素logistic回归分析结果显示:手术时间距离前一次剖宫产时间>5年、术后血红蛋白<110 g/L是剖宫产子宫切口瘢痕憩室术后憩室再形成的影响因素(均P<0.05)。结论剖宫产子宫切口瘢痕憩室术后憩室再形成的发生可能与手术时间距离前一次剖宫产时间>5年、术后血红蛋白<110 g/L等影响因素相关,在临床医疗过程中,应采用针对性的干预措施以减少剖宫产子宫切口瘢痕憩室术后憩室再形成的发生。

Objective To explore the influencing factors of diverticulum formation after caesarean scar diverticulum operation to provide evidence for effective prevention and control measures. Methods The clinical data of 186 patients with scar diverticulum of caesarean section incision who underwent transvaginal surgery in Ningbo Women’s and Children’s Hospital from January 2016 to January 2018 were collected via retrospective investigation. They were divided into non-diverticulum group(96 cases) and diverticulum formation group(90 cases) according to the healing condition after operation. Logistic regression analysis was performed to explore the influencing factors of diverticulum formation after operation. Results Among the 186 patients, 90 had diverticular remodelling, and the incidence of diverticulum remodelling after caesarean section uterine incision scar chamber was 48.39%. The time of postoperative vaginal abnormal bleeding in the diverticulum remodelling group was significantly longer than that of the non-sacral group, and the postoperative vaginal abnormal bleeding time was significantly shorter in the diverticulum re-formation group than that in the non-sacral group(all P<0.05). Univariate analysis revealed that the dilatation of the diverticulum after caesarean section in the uterine incision was significantly associated with preoperative vaginal bleeding time, surgical distance from the last caesarean section, postoperative haemoglobin value and other factors(all P<0.05). Multivariate logistic regression analysis showed that the operation time less than 5 years before the caesarean section, and haemoglobin levels of<110 g/L were the influence factors for diverticulum remodelling after caesarean section uterine incision scar(all P<0.05). Conclusion The occurrence may be related to factors, such as caesarean section time>5 years before operation and haemoglobin levels<110 g/L after operation. In the course of clinical treatment, targeted interventions should be adopted to reduce the occurrence of diverticulum recurrence after caesarean scar diverticulum operation.