Hayakawa Hiromi, Itakura Atsuo, Mitsui Takashi, Okada Mayumi, Suzuki Masaki, Tamakoshi Koji, Kikkawa Fumitaka
Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Japan.
Acta Obstet Gynecol Scand. 2006;85(4):429-34. doi: 10.1080/00016340500430436.
Ultrasound examination is an objective method for assessment of uterine scar defects. The present study was conducted to compare single-layer interrupted sutures (Group A) with double-layer interrupted sutures (Group B) and our new method (Group C) as well as other perioperative parameters in relation to risk of wedge defects in scars.
We have introduced a new myometrium closure procedure consisting of continuous suture with decidual closure followed by interrupted myometrium suture. In this prospective study, women undergoing cesarean operation (n = 137) were examined by transvaginal ultrasound one month after surgery to assess the appearance of lower uterine scars. Multivariate logistic regression analysis was performed to identify associations of perioperative parameters and methods for lower myometrium closure with abnormal wedge formation.
Wedge defects were observed in a total of 27 patients (19.7%). The analysis revealed Groups B and C to have reduced risks with odds ratios of 0.28 and 0.077, respectively, as compared to Group A. Furthermore, increasing gestational week at delivery, plural fetal pregnancies, premature rupture of membranes and pre-eclampsia were also linked with an increased risk, with odds ratios of 1.4-8.9.
The incidence of uterine scar defects 1 month after cesarean sections varies with the method applied for myometrial suture and perioperative variables. The data suggest that methods for myometrium closure as well as other factors influence the condition of myometrial healing.
超声检查是评估子宫瘢痕缺陷的一种客观方法。本研究旨在比较单层间断缝合（A组）、双层间断缝合（B组）和我们的新方法（C组）以及其他围手术期参数与瘢痕楔形缺陷风险的关系。
我们引入了一种新的子宫肌层闭合方法，包括连续缝合加蜕膜闭合，然后间断缝合子宫肌层。在这项前瞻性研究中，对137例行剖宫产手术的妇女在术后1个月进行经阴道超声检查，以评估子宫下段瘢痕的情况。进行多因素逻辑回归分析，以确定围手术期参数和子宫下段肌层闭合方法与异常楔形形成之间的关联。
共观察到27例（19.7%）楔形缺陷。分析显示，与A组相比，B组和C组的风险降低，优势比分别为0.28和0.077。此外，分娩孕周增加、多胎妊娠、胎膜早破和子痫前期也与风险增加有关，优势比为1.4 - 8.9。
剖宫产术后1个月子宫瘢痕缺陷的发生率因子宫肌层缝合方法和围手术期变量而异。数据表明，子宫肌层闭合方法以及其他因素会影响子宫肌层的愈合情况。
