二次剖宫产行子宫瘢痕切除术预防剖宫产切口瘢痕憩室效果的临床研究

发布时间：2018-06-13 23:30

本文选题：二次剖宫产 + 剖宫产切口瘢痕憩室　；参考：《实用妇产科杂志》2017年10期

【摘要】：目的:比较二次剖宫产术中原子宫切口瘢痕切除与否对剖宫产切口瘢痕憩室(PCSD)形成的影响,为临床PCSD的预防提供依据。方法:选取择期二次剖宫产的产妇共360例,其中采用先行原子宫切口瘢痕切除,再双层连续缝合子宫的产妇为研究组,直接行双层连续缝合子宫的产妇为对照组。统计两组手术时间、术中出血量、术后血性恶露持续时间、肛门排气时间、住院天数。术后6月至1年进行随访,评估是否出现异常阴道流血,并在术后1年应用阴道三维超声评估子宫切口愈合情况,分别统计两组产妇形成PCSD的例数,憩室残余子宫肌层厚度及憩室的大小。结果:两组的手术时间、术中出血量、术后血性恶露持续时间、肛门排气时间、住院天数差异均无统计学意义(P0.05);研究组与对照组形成PCSD的例数分别为4例(2.2%)、15例(8.3%);憩室残余子宫肌层厚度均值分别为7.35±1.89 mm、4.98±2.03 mm;憩室容积分别为0.36±0.17 ml、0.53±0.13 ml(P0.01)。结论:二次剖宫产术中切除原子宫切口瘢痕更利于切口愈合,减少PCSD的形成,减轻所形成的PCSD的程度。
[Abstract]:Objective: to compare the effect of scar resection on the formation of PCSDs of scar diverticulum in cesarean section, and to provide evidence for the prevention of clinical PCSD. Methods: a total of 360 parturient women with elective secondary cesarean section were selected. The pregnant women who had undergone scar resection of the original uterine incision and then sutured the uterus with double layers were selected as the study group and the women who underwent the double layer continuous suture of the uterus as the control group. The time of operation, the amount of blood loss, the duration of bleeding, the time of anal exhaust, and the days of hospitalization were counted. The patients were followed up from 6 months to 1 year after operation to assess whether abnormal vaginal bleeding occurred or not, and to evaluate the healing of uterine incision by vagina three-dimensional ultrasound one year after operation. The number of PCSD cases in the two groups were counted respectively. The thickness of residual myometrium of diverticulum and the size of diverticulum. Results: the time of operation, the amount of blood lost during operation, the duration of postoperative bloody lochia, the time of anal exhaust, There was no significant difference in the length of hospitalization (P 0.05), PCSD was formed in 4 cases of PCSD in the study group and in the control group, the mean thickness of the residual myometrium of the diverticulum was 7.35 卤1.89 mm 卤4.98 卤2.03 mm, and the volume of the diverticulum was 0.36 卤0.17 ml 0.53 卤0.13 ml / ml (P 0.01), and the mean value of the residual myometrium thickness of the diverticulum was 7.35 卤1.89 mm / 4.98 卤2.03 mm, respectively. Conclusion: the secondary cesarean section is more beneficial to the wound healing, reducing the formation of PCSD and reducing the degree of PCSD.
【作者单位】：宁波大学医学院附属医院;
【分类号】：R719.8

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