Tarafdari Azadeh, Nazarpour Mahdieh, Zargardzadeh Nikan, Hantoushzadeh Sedigheh, Parsaei Mohammadamin
Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America.
J Family Reprod Health. 2024 Sep;18(3):146-153. doi: 10.18502/jfrh.v18i3.16655.
To compare residual myometrial thickness (RMT) and cesarean scar defect (CSD) development after cesarean section using double-layer locked and unlocked closure techniques.
We conducted a randomized double-blinded trial comparing double-layer locked and unlocked uterine closure techniques following cesarean section in primiparous women. The locked technique involved continuous suturing of the full myometrial thickness in the first layer, followed by back-and-forth needle maneuvering on both sides of the incision for the second layer. The unlocked method included running suturing of two-thirds of the myometrial thickness in the first layer, followed by suturing the upper half of the myometrial thickness in the second layer. Transvaginal ultrasonography was performed one year post-cesarean section, with RMT as the primary outcome and scar depth and width as secondary outcomes. Independent t-test and Chi-square test were utilized for statistical analysis.
All 30 patients from the locked and 26 from the unlocked group in the follow-up were diagnosed with CSD (scar depth>2mm). The mean RMT for the unlocked and locked groups were 4.44±1.07mm and 4.12±0.48mm, respectively, showing no significant difference (p =0.14). There was also no significant difference in mean scar width between the locked and unlocked groups (3.68±1.44mm vs. 3.95±1.00mm, p =0.42). However, the mean scar depth was higher in the unlocked group (3.77±1.11 mm vs. 3.16±1.1mm, p =0.04).
We have found no significant differences in the RMT and CSD prevalence between two-layered locked and unlocked uterine closure techniques, while the scar depth was greater in the unlocked group. Nonetheless, future randomized trials implementing larger sample sizes are required to precisely compare the outcomes of the double-layer locked and unlocked uterine suturing techniques.
比较剖宫产术后采用双层锁定和非锁定缝合技术后的子宫肌层残余厚度（RMT）及剖宫产瘢痕缺损（CSD）的发生情况。
我们进行了一项随机双盲试验，比较初产妇剖宫产术后双层锁定和非锁定子宫缝合技术。锁定技术包括第一层连续缝合子宫肌层全层厚度，然后在切口两侧进行来回缝针操作以完成第二层缝合。非锁定方法包括第一层连续缝合子宫肌层厚度的三分之二，然后第二层缝合子宫肌层厚度的上半部分。剖宫产术后一年进行经阴道超声检查，以RMT作为主要结局指标，瘢痕深度和宽度作为次要结局指标。采用独立t检验和卡方检验进行统计分析。
随访中锁定组的30例患者和非锁定组的26例患者均被诊断为CSD（瘢痕深度>2mm）。非锁定组和锁定组的平均RMT分别为4.44±1.07mm和4.12±0.48mm，差异无统计学意义（p =0.14）。锁定组和非锁定组的平均瘢痕宽度也无显著差异（3.68±1.44mm对3.95±1.00mm，p =0.42）。然而，非锁定组的平均瘢痕深度更高（3.77±1.11mm对3.16±1.1mm，p =0.04）。
我们发现双层锁定和非锁定子宫缝合技术在RMT和CSD发生率方面无显著差异，而非锁定组的瘢痕深度更大。尽管如此，未来仍需要实施更大样本量的随机试验来精确比较双层锁定和非锁定子宫缝合技术的结局。
