摘要
目的:探讨剖宫产术后不同时期患者子宫超声表现,分析瘢痕憩室形成影响因素。方法:选取本院行剖宫产分娩产妇78例,均在剖宫产术后1、3、6个月行阴道超声检查,根据术后子宫瘢痕愈合情况分为良好组(58例)和憩室组(20例)。对比两组术后各时期超声图像变化,并结合临床资料分析瘢痕憩室形成的相关影响因素。结果:两组剖宫产术后1、3、6月时子宫长度、宽度、厚度变化均不明显,组间无差异(P>0.05)。良好组子宫瘢痕超声特征主要包括:瘢痕回声均匀,切口处子宫肌层连续、完整,未见明显缺损,部分可见切口缝线强回声。憩室组超声表现主要为憩室呈低回声或无回声,切口处肌层变薄、断裂缺损,而浆膜层完整连续,周边无血流信号。瘢痕憩室主要呈三角形(65.0%),其次为楔形(20.0%)。瘢痕憩室不同时期的长度、宽度、深度比较有差异(P<0.05),但残余肌层厚度、憩室与宫颈内口距离比较未见差异(P>0.05)。多因素分析显示,剖宫产次数、切口与宫颈内口距离、施术者经验、产褥期感染、子宫位置均是瘢痕憩室形成的影响因素(P<0.05)。结论:子宫前壁切口处肌层变薄,浆膜层完整,肌层缺损低回声或无回声,周围无明显血流信号是剖宫产术后瘢痕憩室的主要超声特征,且憩室大小随着术后时间的延长逐渐减小。瘢痕憩室形成主要受剖宫产次数、施术者经验、产褥期感染、子宫后位等因素的影响。
Objective:To investigate the uterine ultrasound manifestations of women during different periods after cesarean section,and to analyze the influencing factors of their uterine scar diverticulum formation.Methods:78 women after cesarean section were selected as the research objects,and they were all given vaginal ultrasound examination in 1 month,3 months and 6 months after cesarean section.These women were divided into group A(58 women with good heal of uterine scar)and group B(20 women with uterine diverticulum).The changes of uterine ultrasound images of the women during different period after cesarean section were compared between the two groups.And combined with clinical data of the women with uterine scar diverticulum,the related influencing factors of uterine scar diverticulum formation were analyzed.Results:There were no significant different in the changes of the uterine length,width,and thickness of the women in 1,3,and 6 months after cesarean section between the two groups(P>0.05).The ultrasonic characteristics of uterine scar of the women in group A mainly included the scar echo uniformly,the continuous and complete of uterine muscle layer incision without obvious defect,and the strong echo of uterine incision suture in some women.The ultrasonic manifestations of uterine scar of the women in group B were mainly the diverticulum with low echo or no echo,the thin and broken muscle layer at the incision,and the continuous and complete of the serosal layer without peripheral blood flow signal.The percentage of scar diverticulum of triangular was mainly 65.0%,and followed by that(20.0%)of the scar diverticulum of wedge-shaped.There were significant differences in the length,width,and depth of scar diverticulum of the women during different periods after cesarean section(P<0.05),but there were no significant differences in the residual muscle thickness and the distance between diverticulum and cervical endostoma(P>0.05).Multivariate analysis showed that the times of cesarean sections,the distance between incision diverticulum and cervical endostoma,the experience of the operator,the puerperal infection,the uterine position of the women were the influential factors of the scar diverticulum formation(P<0.05).Conclusion:The main ultrasonographic manifestations of uterine scar diverticulum after cesarean section of the women are the thinning of myometrium,the complete serosa layer,the hypoechoic or anechoic myometrial defect without obvious blood flow signal around.The size of scar diverticulum of the women decreases with the prolongation of postoperative time gradually.The scar diverticulum formation is mainly affected by the times of cesarean section,the experiences of the operator,the puerperal infection,the uterine posterior position,and other factors.
作者
范静
李红雨
肖成炜
FAN Jing;LI Hongyu;XIAO Chengwei(The Second Affiliated Hospital of Bengbu Medical College, Anhui Province, 233000)
出处
《中国计划生育学杂志》
2021年第11期2367-2371,2488,共6页
Chinese Journal of Family Planning
关键词
剖宫产
瘢痕憩室
子宫瘢痕愈合
阴道超声图像特征
影响因素
Cesarean section
Scar diverticulum
Uterine scar healing
Vaginal ultrasound
Influencing factors
