不同缝合方式预防剖宫产子宫瘢痕憩室形成的临床观察

Clinical Observation of Different Suture Methods to Prevent the Formation of Previous Cesarean Scar Defect

目的:探究再次行剖宫产术的产妇采用不同缝合方式的效果,为预防剖宫产子宫瘢痕憩室(PCSD)形成提供理论依据。方法:将2020年10月—2022年10月徐州医科大学附属医院妇产科收治的产妇330例随机分成三组,对照组(实施单纯连续缝合)、瘢痕切除组(采取切除瘢痕组织加双层连续缝合)、加固缝合组(针对子宫前壁下段肌层缺损实施加固缝合)各110例。对比三组围手术期指标、月经失调和PCSD形成情况。结果:三组术中出血量、手术时间、尿管拔除时间、肛门排气时间、产后血性恶露持续时间及住院时间比较,差异均无统计学意义(P>0.05);瘢痕切除组和加固缝合组的月经失调率及PCSD形成率均明显低于对照组,剩余子宫肌层厚度均大于对照组,容积均明显小于对照组,差异均有统计学意义(P<0.05);瘢痕切除组月经失调率、PCSD形成率、剩余子宫肌层厚度、容积与加固缝合组比较,差异均无统计学意义(P>0.05)。结论:再次剖宫产术中行切除瘢痕组织加双层连续缝合或针对子宫前壁下段肌层缺损实施加固缝合均能有效预防PCSD形成,减轻PCSD的严重程度,并降低术后月经不调发生率。

Objective:To explore the effect of different suture methods in parturients who underwent cesarean section again,to provide a theoretical basis for preventing the formation of previous cesarean scar defect(PCSD).Method:A total of 330 parturients admitted to Department of Obstetrics and Gynecology,the Affiliated Hospital of Xuzhou Medical University from October 2020 to October 2022 were randomly divided into 3 groups:the control group(with simple continuous suture),the scar resection group(with scar tissue resection plus double-layer continuous suture),and the reinforcement suture group(with reinforcement suture for the inferior anterior uterine wall muscle defect),110 cases in each roup.The perioperative indexes,menoxenia and PCSD formation were compared among the three groups.Result:There were no significant differences in intraoperative blood loss,operation time,urinary tube extraction time,anal exhaust time,postpartum lochia rubra duration and hospital stay among the three groups(P>0.05).The rates of menoxenia and PCSD formation in scar resection group and reinforcement suture group were significantly lower than those in control group,the residual myometrium thickness were greater than those in control group,and volume were significantly smaller than those in control group,the differences were statistically significant(P<0.05).There were no significant differences in the rates of menoxenia and PCSD formation,and residual myometrium thickness and volume between the scar resection group and the reinforcement suture group(P>0.05).Conclusion:Scar tissue resection plus double-layer continuous suture or reinforcement suture for the inferior anterior uterine wall muscle defect can effectively prevent the formation of PCSD,reduce the severity of PCSD,and reduce the incidence of postoperative menoxenia.