子宫下段瘢痕愈合相关因素分析

Analysis of Factors Related to Scar Healing in Lower Uterine Segment

摘要: 目的：探讨术前超声测量瘢痕子宫患者子宫下段瘢痕厚度的价值，以及子宫下段愈合相关影响因素。方法：选择2019年1月~2021年12月在我院行子宫下段剖宫产的911例患者资料进行回顾性分析。于术前1周内超声检查测量子宫下段厚度，根据术中所见将其分为两组，术中见子宫下段瘢痕薄、肌层缺失者定义为子宫下段愈合不良者，此均行子宫下段修补术，此类患者为子宫下段愈合不良者，共计214例；将术中未行子宫下段修补者分为子宫下段愈合良好组，共计697例，对两组患者术前瘢痕厚度、体重增长、产前BMI、两次剖宫产时间间隔、孕次、产次、术中出血、新生儿体重等利用SPSS26.0进行数据分析。结果：子宫下段瘢痕厚度小于1.2 mm其出现子宫下段预后不良风险高(X² = 179.764, P = 0.000)。超声提示子宫下段肌层菲薄不连续出现子宫下段预后不良风险高(X² = 20.871, P = 0.000)，需根据情况尽快结束妊娠。子宫下段瘢痕厚度与产次呈负相关(P = 0.01)，系数−0.11；与剖宫产次数呈负相关(P = 0.01)，系数−0.11；与手术时间呈负相关(P = 0.00)，系数−0.146。子宫下段愈合情况多因素logistic分析发现，子宫下段瘢痕厚度与术后是否发热是瘢痕愈合独立危险因素(P = 0.003, P = 0.000)。方差分析提示：剖宫产次大于2次、末次剖宫产年龄大于35岁其子宫下段愈合不良可能性高(P = 0.037, P = 0.018)，子宫下段愈合不良者其手术时间长、术后出现发热几率高(P = 0.000, P = 0.000)。根据不同高危因素分组发现，子宫下段瘢痕愈合情况与妊娠期糖尿病相关疾病、妊娠期高血压相关疾病、剖宫产时间间隔、宫腔操作次(人工流产或清宫)、不同孕产次、不同孕产、新生儿体重及初次手术前宫口是否开大均无关，差异均无统计学意义(P值均>0.05)。结论：再次剖宫产术前超声测量子宫下段瘢痕厚度对临床有指导意义。子宫下段瘢痕愈合与产次及年龄有关，子宫下段愈合不良者其手术时间长、术后出现发热几率高。

Abstract: Objective: To investigate the value of preoperative ultrasonography in measuring the scar thickness of patients with scar of lower segment of uterus and the related factors affecting the scar healing in the crosscut on the lower uterus of cesarean section. Method: The clinical data of 911 patients who underwent crosscut on the lower uterus of cesarean section in our hospital from January 2019 to December 2021 were analyzed retrospectively. The patients were divided into two groups accord-ing to the findings during the operation. The patients with thin scar and loss of muscular layer of the lower segment of the uterus were defined as poor healing of the lower segment of the uterus, and all of them underwent repair of the lower segment of the uterus. There were 214 cases of poor healing of the lower segment of the uterus. The patients without lower uterine segment repair were divided into the other group. The thickness of the lower segment of the uterus was measured by ultraso-nography within one week before the operation. SPSS 26.0 was used to analyze the preoperative scar thickness, pregnancy weight gain, prenatal BMI, cesarean section interval, pregnancy history or birth times, intraoperative bleeding volume and neonatal weight of the two groups. Results: If the thickness of scar in the lower segment of uterus is less than 1.2 mm, the risk of poor prognosis of incision was higher (2 mm 179.764). Patients with thin and discontinuous scars in the lower seg-ment of the uterus on ultrasound might have a higher risk of poor prognosis of the incision (2 cm 20.871). Pregnancy should be terminated as soon as possible according to the condition. The thick-ness of lower uterine scar was negatively correlated with the number of parturition (P < 0.01), times of cesarean section (P < 0.01), duration of surgery (P < 0.01). Multivariate logistic analysis showed that thin scar in lower segment of uterus and postoperative fever were independent risk factors for scar healing. The analysis of variance showed that the patients with cesarean section more than 2 times and the age of the last cesarean section over 35 years old were more likely to have poor healing of the lower segment of the uterus (P = 0.037, P = 0.018). The patients with poor healing of the lower segment of the uterus had a longer operation time and a higher probability of fever after operation (P = 0.000, P = 0.000). The data analysis found that the scar healing of the lower uterine segment was not related to the following factors: gestational diabetes related diseases, gestational hypertension related diseases, time interval of cesarean section, number of uterine cav-ity operations (induced abortion or curettage), number of pregnancies and births, newborn weight, and whether the uterine orifice was enlarged before the first operation. There was no significant difference between the two groups (P > 0.05). Conclusion: It is of clinical significance to measure the thickness of scar in the lower segment of uterus before cesarean section again. The scar healing of the lower segment of uterus is related to the number of deliveries and age. The patients with poor healing of the lower segment of the uterus have a long operation time and a high rate of fever after operation.