张钧　潘勉

[摘要] 目的 探讨剖宫产手术子宫切口缝合方式与子宫下段肌层愈合情况的相关性。 方法 选取2016年1～9月间我院收治的240例首次分娩方式为剖宫产的产妇，根据首次手术子宫切口肌层的缝合方式分为观察组（单层连续缝合）和对照组（单层连续缝合+平行褥式包埋）各120例，通过超声方式测量患者再次妊娠临产前的子宫下段瘢痕厚度，再次剖宫产术中观察切口愈合情况及盆腹腔粘连情况，对结果进行比较，并比较再次分娩选择阴道试产者的试产成功率。 结果 单层缝合组测得瘢痕处肌层厚度低于双层缝合组[（1.33±0.68）mm vs（1.89±0.71）mm]，但对比瘢痕愈合情况、盆腔粘连率及再次妊娠阴道试产成功率无显著性差异。 结论 两种缝合方法的临床效果良好，值得在临床上进一步应用推广。

[关键词] 剖宫产；子宮切口缝合；瘢痕子宫；单层缝合；双层缝合

[中图分类号] R719.8 [文献标识码] B [文章编号] 1673-9701（2017）24-0067-04

[Abstract] Objective To investigate the correlation between uterine incision suture methods of cesarean section and the healing of myometrium in the lower uterine segment. Methods 240 cases of puerpera whose first delivery method was cesarean section who were admitted to our hospital from January to September 2016 were selected. According to the first surgical uterine incision muscle suture approaches， the patients were divided into observation group （single layer of continuous suture） and control group（single layer of continuous suture+parallel mattress embedding）， with 120 cases in each group. The scar thickness of lower uterine segment before delivery in the re-pregnancy was measured via ultrasound. The patients were given cesarean section once again to observe the incision healing condition and pelvic abdominal adhesion. The results were compared， the success rate of trial delivery in the puerpera who selected trial vaginal delivery in the second delivery was compared. Results The thickness of the myometrium in the scar in the single layer suture group was lower than that of the double layer suture group[（1.33±0.68）mm vs （1.89±0.71）mm]， but there was no significant difference in the success rate of scar healing， pelvic adhesion and re-pregnancy trial vaginal delivery. Conclusion The clinical effect of the two suture methods is favorable， which is worthy of further application in clinical practice.

[Key words] Cesarean section；Incision uterine suture；Scar uterine；Single layer suture；Double layer suture

剖宫产作为处理产程停滞、胎位异常、胎儿宫内缺氧等难产及产科并发症的重要的分娩手段，可显著降低产妇及围产儿死亡率。然而，近年来在控制剖宫产率的同时，剖宫产术中、术后的并发症也备受重视，术后瘢痕是剖宫产后常见问题。随着“全面二胎”政策的铺开，瘢痕子宫再次妊娠成为近年来产科关注的热点问题，剖宫产术后二次妊娠时子宫破裂、胎盘植入、前置胎盘、瘢痕妊娠等问题是导致母婴死亡的严重产科并发症[1]。改善首次剖宫产的子宫切口瘢痕愈合，可为再次妊娠自然分娩提供机会[2]。……