剖宫产宫壁瘢痕缺损相关因素分析

摘要

Objective To identify the factors associated with post-caesarean section scar defectsrn(PCSD).Methods: 101 women who undergone cesarean section at least once in Sun Yat-sen UniversityrnSun Yat-sen Memorial Hospital between January 2008 and April 2009 were followed up by telephone and examination with transvaginal sonography( TVS) during July 2011 and October 2011. Medical records were compared between scar intact and scar defect group,also risk factors correlated with PCSD were analyzed. Results ;Of the total 101 patients,63.4% had a technically adequate PCSD pelvic ultrasound images. The area of the post-caesarean section scars of PCSD was more adjacent to the cervical internal os than the patient with intact scars (5.49 ±1.82 mm vs 6.52 ±2.19 mm) (P< 0.05) ;the percentage of retroflexed uterus was higher in scar defects group than the scar intact group(P< 0.05). There were no significant differences in age,number of Cesarean section,induction of labor,suture material,operation time,blood loss in 24 hours, seniority of operator and breastfeeding time between the two groups ( P>0.05). Uterine retroflexion was shown to be significantly associated with deficient scars ( OR 3.977,95%Cl 1.683 ~9.400). Conclusions: Deficient uterine scar is a frequent finding in women with a previous Cesarean section. Scar with defects is located more adjacent to the cervical internal os. Retroflexed uterus is the risk factor of a PCSD.%目的:探讨剖宫产宫壁瘢痕缺损的相关因素.方法:2008年1月至2009年4月在中山大学孙逸仙纪念医院产科行剖宫产并完成电话随访,且于2011年7～10月期间返院行阴道B超检查的经产妇共101例.比较宫壁瘢痕缺损组及完整组临床资料和危险因素分析.结果:剖宫产宫壁瘢痕缺损的检出率为63.4％.与剖宫产宫壁瘢痕完整组相比,宫壁瘢痕缺损组瘢痕位置更接近宫颈内口(5.49±1.82 mm,6.52±2.19 mm；P＜0.05),宫壁瘢痕缺损组后位子宫较完整组更多(P＜0.05),两组年龄、剖宫产次数、阴道试产、子宫缝合层数、手术时间、24小时失血总量、术者年资、产后母乳喂养时间差异无统计学意义(P＞0.05).子宫后位是剖宫产宫壁缺损的危险因素(OR =3.977,95％CI 1.683 ～9.400,P＜0.01).结论:剖宫产宫壁瘢痕缺损检出率高,瘢痕缺损更接近宫颈内口,子宫后位是其危险因素.