Yılmaz Baran Şafak, Kalaycı Hakan, Doğan Durdağ Gülşen, Yetkinel Selçuk, Alemdaroğlu Songül, Çok Tayfun, Bulgan Kılıçdağ Esra
Department of Obstetrics and Gynecology, Başkent University Faculty of Medicine, Adana, Turkey.
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and IVF Unit, Başkent University Faculty of Medicine, Adana, Turkey.
Acta Obstet Gynecol Scand. 2021 Mar;100(3):531-537. doi: 10.1111/aogs.14018. Epub 2020 Oct 30.
Cesarean deliveries are commonly performed throughout the world. Although the uterine closure technique following this procedure may influence how the uterine scar heals, there is insufficient evidence for choosing the appropriate technique and so preventing long-term negative consequences. This prospective, randomized study examined the effects of single- and double-layer uterine closure techniques on uterine scar healing following cesarean delivery.
This study assessed a total of 282 women aged 18-45 years who were in gestational weeks 24-41 of singleton pregnancies. None had previously undergone uterine surgeries. These participants completed their first cesarean deliveries at the time of study and were randomized into the following two treatment groups: single-layer closure with locking and double-layer closure with locking in the first layer, but not in the second layer (NCT03629028). However, the decidua was not included for treatment in either group. Participants were evaluated at 6-9 months after cesarean section by saline infusion sonohysterography to assess cesarean delivery scar defects. These procedures were conducted by experienced sonographers who were not aware of the uterine closure technique.
Of the 225 final participants, 109 received the single-layer closure technique, whereas 116 received the double-layer technique. The niche rates were 37% (n = 40) for the single-layer group and 45.7% (n = 53) for the double-layer group (P = .22, relative risk 1.4, 95% CI = 0.8-4.4).
The single- and double-layer closure techniques did not produce different impacts on uterine scar niche development.
剖宫产在全球范围内普遍施行。尽管该手术后的子宫缝合技术可能会影响子宫瘢痕的愈合方式，但目前尚无足够证据来选择合适的技术以避免长期的不良后果。本前瞻性随机研究探讨了单层和双层子宫缝合技术对剖宫产术后子宫瘢痕愈合的影响。
本研究共评估了282名年龄在18至45岁之间、单胎妊娠24至41孕周的女性。此前均未接受过子宫手术。这些参与者在研究时完成了首次剖宫产，并被随机分为以下两个治疗组：单层锁边缝合组和双层缝合组，双层缝合组的第一层采用锁边缝合，第二层不采用（NCT03629028）。然而，两组均不包括蜕膜的处理。剖宫产术后6至9个月，通过盐水灌注超声子宫造影对参与者进行评估，以评估剖宫产瘢痕缺损情况。这些操作由不了解子宫缝合技术的经验丰富的超声检查人员进行。
在225名最终参与者中，109人接受了单层缝合技术，而116人接受了双层技术。单层组的切口憩室发生率为37%（n = 40），双层组为45.7%（n = 53）（P = 0.22，相对风险1.4，95%可信区间 = 0.8 - 4.4）。
单层和双层缝合技术对子宫瘢痕憩室的形成没有产生不同的影响。
