剖宫产术中不同缝合方法与子宫瘢痕憩室的关系探析
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摘要
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.
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.
引文
[1]陈晓端,石一复.剖宫产后瘢痕部位相关病变临床及病理改变[J].中华病理学杂志,2016,45(10):731-733.
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[4]郑媛媛,邹丽颖,范玲.新产程标准实施后产程中剖宫产指征的变化及母儿预后分析[J].中华妇产科杂志,2016,51(4):245-249.
[5]张世妹,周丹,彭萍.剖宫产子宫瘢痕憩室诊断和治疗进展[J].中国实用妇科与产科杂志,2015,31(2):174-176.
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[7]苏冠男,王武亮,袁博,等.子宫切口瘢痕憩室形成的相关因素研究[J].中国全科医学,2015,18(4):421-424.
[8]王燕燕,陈俊虎,张秀果,等.两种缝合技术对形成剖宫产子宫切口疤痕憩室的比较[J].昆明医科大学学报,2017,38(2):62-65.
[9]曹晓明,黄庆,史玉爽,等.不同剖宫产缝合方式对子宫切口瘢痕憩室形成的影响[J].中国计划生育和妇产科,2017,9(3):31-33.
[10]张培,王欣.剖宫产术后子宫瘢痕憩室的诊治[J].江苏医药,2015,41(4):447-449.
[11]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,2016,45(2):158-161.
[12]邢忠兴,刘俊凤,董艳蕊,等.剖宫产子宫切口缝合方法与再次剖宫产切口厚度的相关性研究[J].中国医药导刊,2016,18(2):119-120.
[13]张丽丽,李卓月.剖宫产单、双层缝合方式对术后康复及二次妊娠的影响[J].检验医学,2016,31(B09):187-188.
[2]张勤建,颜建英.剖宫产瘢痕子宫妊娠期管理[J].实用妇产科杂志,2018,34(1):3-6.
[3]王静璇,卢丹,魏薇.剖宫产切口憩室发病危险因素探讨[J].武警医学,2017,28(3):265-267.
[4]郑媛媛,邹丽颖,范玲.新产程标准实施后产程中剖宫产指征的变化及母儿预后分析[J].中华妇产科杂志,2016,51(4):245-249.
[5]张世妹,周丹,彭萍.剖宫产子宫瘢痕憩室诊断和治疗进展[J].中国实用妇科与产科杂志,2015,31(2):174-176.
[6]王秋云,曾庆华.剖宫产术子宫切口肌层单层缝合与双层缝合的对比研究[J].中国临床研究,2015,28(10):1344-1346.
[7]苏冠男,王武亮,袁博,等.子宫切口瘢痕憩室形成的相关因素研究[J].中国全科医学,2015,18(4):421-424.
[8]王燕燕,陈俊虎,张秀果,等.两种缝合技术对形成剖宫产子宫切口疤痕憩室的比较[J].昆明医科大学学报,2017,38(2):62-65.
[9]曹晓明,黄庆,史玉爽,等.不同剖宫产缝合方式对子宫切口瘢痕憩室形成的影响[J].中国计划生育和妇产科,2017,9(3):31-33.
[10]张培,王欣.剖宫产术后子宫瘢痕憩室的诊治[J].江苏医药,2015,41(4):447-449.
[11]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,2016,45(2):158-161.
[12]邢忠兴,刘俊凤,董艳蕊,等.剖宫产子宫切口缝合方法与再次剖宫产切口厚度的相关性研究[J].中国医药导刊,2016,18(2):119-120.
[13]张丽丽,李卓月.剖宫产单、双层缝合方式对术后康复及二次妊娠的影响[J].检验医学,2016,31(B09):187-188.