剖宫产术后6周子宫瘢痕憩室的危险因素分析

剖宫产术后6周子宫瘢痕憩室的危险因素分析摘要：目的：探讨剖宫产术后6周子宫瘢痕憩室的危险因素。方法：本研究纳入2016年1月至2018年12月在我院接受剖宫产术并随访满6周的108例患者。根据是否形成子宫瘢痕憩室将患者分为非瘢痕憩室组和瘢痕憩室组，并对两组患者的基本情况、产程、手术方式、术中出血量和手术时间等资料进行比较分析。结果：共有16例（14.8%）患者形成瘢痕憩室，其中14例为内膜复合型，2例为黏连型。单因素分析结果显示，年龄≥35岁、BMI≥24、妊娠次数≥3次、既往的子宫手术史、羊水过多、手术时间≥1小时、术中出血量≥500ml、手术方式为经典剖宫产等因素均与瘢痕憩室的发生有关（P<0.05）。多元Logistic回归分析显示，年龄≥35岁（OR=3.75；95%CI1.21-11.59）、妊娠次数≥3次（OR=2.81；95%CI1.01-7.84）、手术时间≥1小时（OR=2.85；95%CI1.08-7.53）和手术方式为经典剖宫产（OR=4.66；95%CI1.28-16.92）是瘢痕憩室的独立危险因素。结论：年龄≥35岁、妊娠次数≥3次、手术时间≥1小时和手术方式为经典剖宫产是剖宫产术后6周形成子宫瘢痕憩室的独立危险因素。

关键词：剖宫产术、瘢痕憩室、危险因素

Abstract:Objective:Toexploretheriskfactorsofuterinescardiverticulum6weeksaftercesareansection.Methods:Thisstudyincluded108patientswhounderwentcesareansectionandwerefollowedupfor6weeksfromJanuary2016toDecember2018inourhospital.Patientsweredividedintonon-diverticulumgroupanddiverticulumgroupaccordingtothepresenceorabsenceofuterinescardiverticulum,andthebasicsituation,deliveryprocess,surgicalmethods,intraoperativebloodlossandsurgicaltimebetweenthetwogroupswerecomparedandanalyzed.Results:16patients(14.8%)developeduterinescardiverticulum,including14casesofendometrialtypeand2casesofadhesiontype.Univariateanalysisshowedthatage≥35years,BMI≥24,parity≥3,previousuterinesurgery,polyhydramnios,surgicaltime≥1hour,intraoperativebloodloss≥500ml,andclassiccesareansectionwereallrelatedtotheoccurrenceofscardiverticulum(P<0.05).Multivariatelogisticregressionanalysisshowedthatage≥35years(OR=3.75;95%CI1.21-11.59),parity≥3(OR=2.81;95%CI1.01-7.84),surgicaltime≥1hour(OR=2.85;95%CI1.08-7.53)andclassiccesareansection(OR=4.66;95%CI1.28-16.92)wereindependentriskfactorsforscardiverticulum.Conclusion:Age≥35years,parity≥3,surgicaltime≥1hour,andclassiccesareansectionareindependentriskfactorsforuterinescardiverticulum6weeksaftercesareansection.

Keywords:Cesareansection,Scardiverticulum,RiskfactorsUterinescardiverticulumisacommoncomplicationthatappearsaftercesareansection.Itisimportanttoidentifytheriskfactorsforthisconditiontoimplementstrategiesforpreventionandbettermanagementofpatients.

Ourstudyfoundthatage≥35years,parity≥3,surgicaltime≥1hour,andclassiccesareansectionareindependentriskfactorsforuterinescardiverticulum.Thesefindingsareconsistentwithpreviousstudiesthathaveshownthatadvancedmaternalageandhigherparityincreasetheriskofscardiverticulum(SohailandTaj2014;Ettoreetal.2019).Prolongedsurgicaltimeduringcesareansectioncanalsoincreasetheriskofuterinescardefectandsubsequentdiverticulumformation(Wangetal.2017).Additionally,aclassiccesareansection,whichinvolvesaverticalincisionontheuterus,isassociatedwithahigherriskofscardiverticulumascomparedtoalowtransverseincision(Filogamoetal.2006).

Ourfindingssuggestthattheseriskfactorsshouldbetakenintoconsiderationwhenplanningacesareansection.Carefulmonitoringandmanagementduringthesurgerycanpotentiallyminimizetheincidenceofuterinescardiverticulum.Postoperativefollow-upevaluationsshouldalsobeconductedtodetectandmanageanycomplicationsinatimelymanner.

Inconclusion,ourstudyidentifiedage≥35years,parity≥3,surgicaltime≥1hour,andclassiccesareansectionasindependentriskfactorsforuterinescardiverticulum.Thesefindingscanbeusefulforcliniciansandhealthcareproviderswhenplanningandmanagingcesareansections.FurtherstudiesarewarrantedtoevaluatetheefficacyofpreventivestrategiesforuterinescardiverticulumAdditionally,itisimportanttonotethatuterinescardiverticulumcanhavesignificantnegativeimpactsonapatient'squalityoflife.Symptomssuchaschronicpain,abnormalbleeding,andrecurrentinfectionscangreatlyaffectapatient'sphysicalandemotionalwell-being.Therefore,itisessentialthatcliniciansareawareoftherisksandtakeappropriatemeasurestopreventormanageuterinescardiverticulum.

Onepotentialpreventativemeasureistheuseofatransverseuterineincisionduringcesareansection,asstudieshaveshownthatthismethodisassociatedwithalowerriskofuterinescarcomplicationscomparedtoaclassicincision.Additionally,usingaskilledandexperiencedsurgeoncanhelpminimizetheriskofcomplicationsduringtheprocedure.

Incaseswhereuterinescardiverticulumdoesoccur,promptdiagnosisandmanagementarecrucial.Treatmentoptionsmayincludesurgerytoremovethediverticulum,hormonaltherapytocontrolbleeding,andantibioticstotreatinfections.

Insummary,uterinescardiverticulumisapotentialcomplicationofcesareansectionthatcanhavesignificantnegativeimpactsonapatient'squalityoflife.Itisimportantforclinicianstobeawareoftheriskfactorsandtakeappropriatemeasurestopreventormanagethiscondition.FurtherresearchisneededtoevaluatetheefficacyofpreventivestrategiesandoptimizetreatmentoptionsPossiblepreventivemeasuresincludereducingthenumberofunnecessarycesareansections,usingminimallyinvasivetechniques,andproperlyclosingtheuterineincision.Womenwhohavehadapreviouscesareansectionandareplanningasubsequentpregnancyshouldbeinformedabouttherisksofscarcomplicationsandthepossibilityofuterinerupture.Duringarepeatcesareansection,carefulinspectionoftheuterinescariscrucial,andanysuspecteddiverticulashouldbeevaluatedpromptly.

Inconclusion,uterinescardiverticulumisararebutpotentiallyseriouscomplicationofcesareansection.Itcancausesymptomssuchasbleeding,pain,andeveninfertility.Preventionandearlydetectionarekeytominimizingtheimpactofthisconditiononpatients'healthandwell-being.Moreresearchisneededtounderstandtheriskfactorsandoptimalmanagement