Zampieri Giorgia, Nitescu Bianca, Pacu Irina, Neacsu Adrian, Ionescu Cringu Antoniu
Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania.
Department of Obstetrics and Gynecology, Saint Pantelimon Emergency Clinical Hospital, 021659 Bucharest, Romania.
Biomed Rep. 2024 Oct 15;22(1):2. doi: 10.3892/br.2024.1881. eCollection 2025 Jan.
Isthmocele, also known as uterine niche, refers to a myometrial defect of the anterior wall of the uterine isthmus, specifically at the site of the previous C-section scar. The prevalence of isthmocele has increased in tandem with the rise in deliveries by caesarean section. Risk factors include aspects related to the surgical procedure. The present study aimed to assess the relationship between various suture types and the development of a niche. The analysis of the present study is based on data collected from the evaluation of 52 patients, 6 weeks post C-section performed in 'Saint Pantelimon' Hospital in Bucharest, Romania. The parameters examined included patient age, the number of previous births by C-section, the type of suture used and uterine anatomy. Out of all the 52 patients, 42.3% developed an isthmocele. The results confirm a significant association between the presence of the niche and the type of suture of the first layer, proving that when non-locking continuous suture was used, the absence of niche was observed in most cases, while using the locking continuous suture was associated with more niches. Using the continuous locking suture for the first layer was associated with severe niches, while no severe niches were observed in patients with the other two types of sutures. There is a statistically significant association between the use of continuous locking sutures for uterine closure in the first layer and the development of a uterine niche. Furthermore, all instances of severe niches were linked to this type of suture, compared with continuous non-locking suture or interrupted suture. Given the escalating rate of C-sections, further research is crucial to identify the suture type that minimizes the risk of isthmocele formation. The present study's limitations revolve around its exclusive focus on a single institution and the relatively small sample size.
子宫峡部憩室，也称为子宫切口憩室，是指子宫峡部前壁的肌层缺损，具体位于既往剖宫产瘢痕处。随着剖宫产分娩率的上升，子宫峡部憩室的患病率也随之增加。危险因素包括与手术操作相关的方面。本研究旨在评估不同缝合类型与憩室形成之间的关系。本研究的分析基于从罗马尼亚布加勒斯特“圣潘泰利蒙”医院对52例剖宫产术后6周患者的评估中收集的数据。检查的参数包括患者年龄、既往剖宫产次数、使用的缝合类型和子宫解剖结构。在所有52例患者中，42.3%出现了子宫峡部憩室。结果证实憩室的存在与第一层缝合类型之间存在显著关联，证明使用非锁定连续缝合时，大多数情况下未观察到憩室，而使用锁定连续缝合则与更多憩室相关。第一层使用连续锁定缝合与严重憩室相关，而其他两种缝合类型的患者未观察到严重憩室。第一层子宫缝合使用连续锁定缝合与子宫憩室的形成之间存在统计学上的显著关联。此外，与连续非锁定缝合或间断缝合相比，所有严重憩室病例均与这种缝合类型有关。鉴于剖宫产率不断上升，进一步研究对于确定能将子宫峡部憩室形成风险降至最低的缝合类型至关重要。本研究的局限性在于仅专注于单一机构且样本量相对较小。
