基于既往剖宫产史女性腹部瘢痕特征预测腹腔粘连及子宫瘢痕分级：一项诊断准确性研究。
Prediction of Intra-abdominal Adhesions and Uterine Scar Grade Based on Abdominal Scar Characteristics in Women With a Previous Cesarean Section: A Diagnostic Accuracy Study.
作者信息
Durai Vignesh, Dorairajan Gowri
机构信息
Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
出版信息
Eplasty. 2025 Jan 29;25:e5. eCollection 2025.
BACKGROUND
This study aims to investigate the relationship between cutaneous scar morphology and severe intra-abdominal adhesions and to predict uterine scar grade in repeat cesarean sections. It could be a valuable tool to plan elective repeat cesarean sections in patients with predicted weak uterine scars and also to have an experienced surgeon for repeat cesareans in patients predicted to have dense intra-abdominal adhesions.
METHODS
Preoperatively, the external scar was assessed using the Manchester score in 260 women. Intraoperatively, the Knightly score was used for adhesions at 5 different sites. The total adhesion score was categorized into scores ≤5 and >5 (severe adhesions). The uterine scar was graded using the Qureshi method and grouped into intact scar and weak scar (grades 3 and 4). Fischer exact and chi-square tests were used to compare the groups. The receiver operating characteristic curve calculated a cutoff score for predicting severe adhesions and weak scars.
RESULTS
Of the 260 patients, 63.5% had adhesions and 36.5% had no adhesions. The distortion of the skin scar had 71.3% specificity, and the texture had 84.8% sensitivity in predicting severe adhesions. Similarly, the texture had 72.2% sensitivity, and the distortion had 68.3% specificity in predicting weak uterine scar. A Manchester Scar Scale score of 9 includes the area under the curve of 0.72 for predicting severe adhesions and 0.62 for predicting weak uterine scar. A score of 9 was 66.6% sensitive and 66.5% specific, with a negative predictive value (NPV) of 93.2% for predicting severe adhesions. The same score was 55.5% sensitive and 65.1% specific, with an NPV of 90.1% for predicting weak uterine scar.
CONCLUSIONS
A Manchester Scar Scale cutoff score of 9 has a high NPV for predicting severe adhesions and weak uterine scar. The texture had high sensitivity, and distortion had high specificity for predicting severe adhesions.
背景
本研究旨在探讨皮肤瘢痕形态与严重腹腔内粘连之间的关系，并预测再次剖宫产术中子宫瘢痕分级。对于预测子宫瘢痕薄弱的患者，它可能是规划择期再次剖宫产的有价值工具，对于预测有致密腹腔内粘连的患者，有经验的外科医生进行再次剖宫产也是如此。
方法
术前，采用曼彻斯特评分对260名女性的外部瘢痕进行评估。术中，使用奈特利评分对5个不同部位的粘连情况进行评估。总粘连评分分为≤5分和>5分（严重粘连）。采用库雷希方法对子宫瘢痕进行分级，并分为完整瘢痕和薄弱瘢痕（3级和4级）。使用费舍尔精确检验和卡方检验对各组进行比较。通过绘制受试者工作特征曲线计算预测严重粘连和薄弱瘢痕的临界值。
结果
260例患者中，63.5%有粘连，36.5%无粘连。皮肤瘢痕的扭曲在预测严重粘连时特异性为71.3%，质地的敏感性为84.8%。同样，质地在预测薄弱子宫瘢痕时敏感性为72.2%，扭曲的特异性为68.3%。曼彻斯特瘢痕量表评分为9分时，预测严重粘连的曲线下面积为0.72，预测薄弱子宫瘢痕的曲线下面积为0.62。评分为9分时，预测严重粘连的敏感性为66.6%，特异性为66.5%，阴性预测值（NPV）为93.2%。同一评分预测薄弱子宫瘢痕时敏感性为55.5%，特异性为65.1%，NPV为90.1%。
结论
曼彻斯特瘢痕量表临界值为9分时，预测严重粘连和薄弱子宫瘢痕的NPV较高。质地在预测严重粘连时具有高敏感性，扭曲具有高特异性。
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