目的 探讨剖宫产切口憩室(previous cesarean scar defect, PCSD)发病的危险因素。方法 选择2013-01至2015-12因剖宫产切口憩室就诊于我院妇科的患者56例,以及在此期间于我院行剖宫产并术后复查子宫切口愈合良好者72例为研究对象,分别作为病例组及对照组。回顾性分析两组临床资料,包括一般情况:年龄、子宫位置、孕周、产次、剖宫产次、新生儿体重;围术期情况:有无合并妊娠期糖尿病、妊娠期高血压疾病、胎膜早破及产褥感染;剖宫产手术时机(择期、潜伏期、活跃期)以及子宫切口缝合方式(单层全层缝合或双层缝合),分析剖宫产切口憩室发病的危险因素。结果 病例组中子宫后位者比例、产次及剖宫产次、妊娠期糖尿病的比例、进入产程的剖宫产数及子宫切口采用单层缝合的比例均高于对照组,差异有统计学意义(P<0.05)。将其纳入多因素非条件logistic回归分析,结果 提示后位子宫(OR=0.370, P<0.05)、多次剖宫产(OR=0.147, P<0.05)、已进入产程的剖宫产(OR=0.543, P<0.05)及子宫切口单层缝合(OR=11.126, P<0.05)是形成PCSD的危险因素。结论 严格掌握剖宫产术适应证、选择适宜的手术时机、提高手术操作技术水平是降低剖宫产切口憩室发病风险的有效手段。
Abstract
Objective To analyze the risk factors for previous cesarean scar defect.Methods Totally 128 patients who had received cesarean section were recruited in the study. Fifty-six of the cases came to visit a doctor because of previous cesarean scar defect between January 2013 and December 2015, while the other seventy-two cases had their scars healed under the vaginal ultrasound and with no symptoms related to previous cesarean scar defect .The medical records included general conditions(age, uterine position, gestational age, gravidity and parity history and neonatal weight) and perioperative conditions (pregnancy complications, puerperal infection, time of operation, and ways of incision suture) were collected. Risk factors for previous cesarean scar defect were analyzed.Results There were more cases of retroflexed uterus, delivery, cesarean sections, patients with gestational diabetes mellitus, cesarean sections during the second stage of labor, and more cases of single layer closure incision (P<0.05) in the group with previous cesarean scar defect. The risk factors for previous cesarean scar defect were the retroflexed uterus(OR=0.370, P<0.05), multiple cesarean sections(OR=0.147, P<0.01), cesarean sections during the second stage of labor (OR=0.543, P<0.05), and incisions with single layer closure(OR=11.126, P<0.05).Conclusions Rigorous control of indications, proper timing of cesarean sections, and improving surgical expertise are effective means of reducing the risk of previous cesarean scar defect.
关键词
剖宫产术 /
术后并发症 /
瘢痕憩室 /
危险因素
Key words
cesarean section /
postoperative complications /
diverticulum /
risk factors
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参考文献
[1] Vikhareva Osser O, Valentin L. Risk factors for incomplete healing of the uterine incision after caesarean section [J]. BJOG: An Inter J Obstetrics & Gynaecology, 2010, 117(9):1119-1126.
[2] Uppal T, Lanzarone V, Mongelli M. Sonographically detected caesarean section scar defects and menstrual irregularity [J]. J Obstet Gynaecol, 2011, 31(5):413-416.
[3] Vikhareva Osser O, Jokubkiene L, Valentin L. High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination [J]. Ultrasound in Obstetrics and Gynecology, 2009,34(1):90-97.
[4] Melo-Cerda I. Cesarean scar defect [J]. Ginecol Obstet Mex, 2014, 82(8):530-534.
[5] Tower A M, Frishman G N. Cesarean Scar Defects: An Underrecognized Cause of Abnormal Uterine Bleeding and Other Gynecologic Complications [J]. J Minim Invasive Gyneco, 2013, 20(5):562-572.
[6] Voet L F, Bij De Vaate A M, Veersema S, et al. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding [J]. BJOG: An Inter J Obstetrics & Gynaecology, 2014, 121(2):236-244.
[7] Bij D A, Voet L F, Naji O, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review [J]. Ultrasound Obstet Gynecol, 2014, 43(4):372-382.
[8] 韦春姣,陈立斌,冯淑英,等. 剖宫产宫壁瘢痕缺损相关因素分析[J]. 实用妇产科杂志, 2012,19(9):777-780.
[9] Roberge S, Demers S, Berghella V, et al. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis [J]. Am J Obstet Gynecol, 2014, 211(5):453-460.
[10] Lin Y H, Hwang J L, Seow K M. Endometrial ablation as a treatment for postmenstrual bleeding due to cesarean scar defect [J]. Int J Gynaecol Obstet, 2010, 111(1):88-89.
[11] Luo L, Niu G, Wang Q, et al. Vaginal repair of cesarean section scar diverticula[J]. J Minim Invasive Gynecol, 2012, 19(4):454-458.
[12] Wang C B, Chiu W W C, Lee C Y, et al. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position [J]. Ultrasound in Obstetrics and Gynecology, 2009, 34(1):85-89.
[13] 王怡佳,陈 燕,韩 萍,等. 剖宫产术后子宫切口憩室形成影响因素分析[J]. 河北联合大学学报(医学版), 2016,16(2):115-118.
[14] 王艺桦,马 琳,阚艳敏,等. 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[J]. 中国医科大学学报, 2016,17(2):158-161.
基金
首都医科大学附属北京妇产医院中青年学科骨干培养专项(fcyy201409)
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