目的:探讨子宫肌层3层缝合对剖宫产术后憩室大小的影响及子宫切口憩室(CSD)形成的相关因素。方法:回顾性分析2022年4～11月于华东师范大学附属芜湖医院行剖宫产术的240例产妇的临床资料，根据子宫肌层缝合方式的不同分为3层缝合组(124例)和双层缝合组(116例);另根据术后是否形成CSD将产妇分为CSD组(23例)和非CSD组(217例)。对比3层缝合组与双层缝合组产妇的临床特点，采用多因素Logistic回归分析CSD形成的独立影响因素并构建人工神经网络模型;采用受试者工作特征(ROC)曲线、校准曲线和临床决策曲线进行模型验证。结果:①3层缝合组产妇的子宫肌层瘢痕厚度显著高于双层缝合组(7。06±2。09 mm vs。5。68±1。97 mm);而CSD形成情况(4。03％vs。15。52％)和憩室大小(0。36±0。09 ml vs。0。47±0。12 ml)则显著低于双层缝合组，差异均有统计学意义(P＜0。05);②多因素分析示，子宫后屈、剖宫产次数≥2次、胎膜早破、围产期感染、剖宫产时机(择期)是影响CSD形成的独立危险因素(OR＞1，P＜0。05)，而子宫肌层3层缝合是保护性因素(OR＜1，P＜0。05);③人工神经网络预测模型显示剖宫产次数、胎膜早破以及是否进行3层缝合所占权重均较高，经ROC曲线、校准曲线和临床决策曲线验证表明该模型预测能力良好。结论:CSD的形成与子宫后屈、剖宫产次数、胎膜早破、围产期感染、剖宫产时机等指标有关，临床应重点关注，此外，子宫肌层3层缝合可降低CSD的形成概率，在临床上值得推广应用。
The Effect of Three-Layer Suturing of Myometrium on the Size of Diverticulum after Caesarean Section and the Analysis of Related Factors of the Formation of Diverticulum in Uterine Incision
Objective:To investigate the effect of three-layer suturing of myometrium on the size of diverticu-lum after cesarean section and the related factors of the formation of uterine incision diverticulum(CSD).Meth-ods:The clinical data of 240 parturients who underwent cesarean section in Wuhu Hospital affiliated to East China normal University from April to November 2022 were analyzed retrospectively.According to the different suture methods of myometrium,they were divided into three-layer suture group(n=124)and double-layer suture group(n=116).According to the formation of CSD after operation,the parturients were divided into CSD group(n=23)and non-CSD group(n=217).The clinical characteristics of parturients in three-layer suture group and doub-le-layer suture group were compared.Multivariate Logistic regression were used to analyze the independent fac-tors affecting the formation of CSD and an artificial neural network model was constructed.The model was verified by receiver operating characteristics(ROC),calibration curve and clinical decision curve.Results:①The thick-ness of myometrium scar in the three-layer suture group was significantly higher than that in the double-layer su-ture group(7.06±2.09 mm vs.5.68±1.97 mm),while the formation of CSD(4.03％vs.15.52％)and the size of diverticulum(0.36±0.09 ml vs.0.47±0.12 ml)were significantly lower than those in the double-layer suture group(P＜0.05).②Multivariate analysis showed that retroflexion of uterus,cesarean section frequency ≥2 times,premature rupture of membranes,perinatal infection and timing of cesarean section were independent risk factors for the formation of CSD(OR＞1,P＜0 05),while three layer suture of myometrium was a protective factor(OR＜1,P＜0.05).③The artificial neural network prediction model showed that the weights of cesarean section frequency,premature rupture of membranes and three-layer suture were higher.The ROC curve,calibration curve,and clinical decision curve validation showed that the model had good predictive ability.Conclusions:The formation of CSD is related to indicators such as retroflexion of uterus,times of cesarean section,premature rup-ture of membranes,perinatal infection and timing of cesarean section.Clinical attention should be focused on this.In addition,three-layer suture of myometrium can reduce the probability of formation of CSD,which is worth popu-larizing and application in clinic.
万方数据
维普
