Department of Obstetrics & Gynaecology, Santa Maria Hospital, Bari, Italy.
Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):300-4. doi: 10.1016/j.ejogrb.2011.09.001. Epub 2011 Oct 11.
To evaluate the effect of bladder flap formation (BFF) during caesarean section (CS) on the uterine scar, assessed during repeat CS.
One hundred and fifteen women undergoing their first CS were divided into two groups: 58 women had a CS with BFF (Group 1) and 57 women had a CS without BFF (Group 2). During the repeat CS, four specimens from the uterine scar from the first CS were collected from each woman, and evaluated by light microscopy and transmission electron microscopy (TEM).
Adhesions were found in 28 (48.3) women in Group 1 and 14 (24.1%) women in Group 2 (p<0.01). Of the women with adhesions in Group 1, 20 (71.4%) had mild adhesions and eight (28.6%) had severe adhesions. Of the women with adhesions in Group 2, eight (57.1%) had mild adhesions and six (42.9%) had severe adhesions. Light microscopy revealed significant differences in submesothelial fibrosis (39.6% vs 12.2%; p<0.01) and neo-angiogenesis of the mesothelial stroma (46.5% vs 21%; p<0.01) in Groups 1 and 2, respectively. TEM revealed more specimens with inflammatory cells in Group 1 compared with Group 2 {mean 29.7 [standard deviation (SD) 1.3] vs 18.2 (SD 1.9) patients; p<0.01}.
BFF during CS leads to an inflammatory and fibrotic reaction, resulting in inflammation reactive and regenerative processes, mesothelial hyperplasia and submesothelial fibrosis. CS without BFF reduces the inflammatory processes and the subsequent intraperitoneal adhesions and adhesions between the bladder and uterus.
评估剖宫产术中膀胱瓣形成（BFF）对再次剖宫产时子宫瘢痕的影响。
115 名接受首次剖宫产的妇女分为两组：58 名妇女行剖宫产术伴 BFF（组 1），57 名妇女行剖宫产术不伴 BFF（组 2）。在再次剖宫产时，从每位妇女的第一次剖宫产子宫瘢痕处采集 4 个标本，行光镜和透射电镜（TEM）检查。
组 1 中 28 例（48.3%）和组 2 中 14 例（24.1%）有粘连（p<0.01）。组 1 中粘连的妇女 20 例（71.4%）为轻度粘连，8 例（28.6%）为重度粘连；组 2 中粘连的妇女 8 例（57.1%）为轻度粘连，6 例（42.9%）为重度粘连。光镜下发现组 1 与组 2 相比，亚膜下纤维化（39.6%比 12.2%；p<0.01）和间皮基质的新生血管形成（46.5%比 21%；p<0.01）有显著差异。TEM 显示组 1 中有更多的标本有炎症细胞，与组 2 相比[平均 29.7（标准差 1.3）比 18.2（标准差 1.9）例；p<0.01]。
剖宫产术中 BFF 导致炎症和纤维化反应，导致炎症反应性和再生过程、间皮增生和亚膜下纤维化。无 BFF 的剖宫产术减少了炎症过程和随后的腹腔内粘连以及膀胱和子宫之间的粘连。
