Bamberg Christian, Hinkson Larry, Dudenhausen Joachim W, Bujak Verena, Kalache Karim D, Henrich Wolfgang
Department of Obstetrics, Charité-University Medical Center, Berlin, Germany.
Acta Obstet Gynecol Scand. 2017 Dec;96(12):1484-1489. doi: 10.1111/aogs.13213. Epub 2017 Sep 21.
Cesarean deliveries are the most common abdominal surgery procedure globally, and the optimal way to suture the hysterotomy remains a matter of debate. The aim of this study was to assess the incidence of cesarean scar niches and the depth after single- or double-layer uterine closure.
We performed a randomized controlled trial in which women were allocated to three uterotomy suture techniques: continuous single-layer unlocked, continuous locked single-layer, or double-layer sutures. Transvaginal ultrasound was performed six weeks and 6-24 months after cesarean delivery [Clinicaltrials.gov (NCT02338388)].
The study included 435 women. Six weeks after delivery, the incidence of niche was not significantly different between the groups (p = 0.52): 40% for single-layer unlocked, 32% for single-layer locked and 43% for double-layer sutures. The mean ± SD niche depths were 3.0 ± 1.4 mm for single-layer unlocked, 3.6 ± 1.7 mm for single-layer locked and 3.3 ± 1.3 mm for double-layer sutures (p = 1.0). There were no significant differences (p = 0.58) in niche incidence between the three groups at the second ultrasound follow up: 30% for single-layer unlocked, 23% for single-layer locked and 29% for double-layer sutures. The mean ± SD niche depth was 3.1 ± 1.5 mm after single-layer unlocked, 2.8 ± 1.5 mm after single-layer locked and 2.5 ± 1.2 mm after double-layer sutures (p = 0.61). There was a trend (p = 0.06) for the residual myometrium thickness to be thicker after double-layer repair at the long-term follow up.
The incidence of cesarean scar niche formation and the niche depth was independent of the hysterotomy closure technique.
剖宫产是全球最常见的腹部外科手术，子宫切口的最佳缝合方式仍存在争议。本研究的目的是评估单层或双层子宫缝合后剖宫产瘢痕憩室的发生率及深度。
我们进行了一项随机对照试验，将女性分为三种子宫切口缝合技术组：连续单层非锁定、连续锁定单层或双层缝合。剖宫产术后六周及6至24个月进行经阴道超声检查[Clinicaltrials.gov（NCT02338388）]。
该研究纳入了435名女性。产后六周时，各组间憩室发生率无显著差异（p = 0.52）：单层非锁定组为40%，单层锁定组为32%，双层缝合组为43%。单层非锁定组憩室平均深度±标准差为3.0±1.4mm，单层锁定组为3.6±1.7mm，双层缝合组为3.3±1.3mm（p = 1.0）。第二次超声随访时，三组间憩室发生率无显著差异（p = 0.58）：单层非锁定组为30%，单层锁定组为23%，双层缝合组为29%。单层非锁定组憩室平均深度±标准差为3.1±1.5mm，单层锁定组为2.8±1.5mm，双层缝合组为2.5±1.2mm（p = 0.61）。长期随访时，双层修复后残留肌层厚度有增厚趋势（p = 0.06）。
剖宫产瘢痕憩室形成的发生率及憩室深度与子宫切口闭合技术无关。
