Preliminary Study On The Clinical Effect Of Reinforcement Suture Of The Lower Uterus In Patients With Muscular Defect At Uterine Scar During The Second Cesarean Section

Objective:To explore the safety of the lower uterine reinforcement suture and the effectiveness of promoting the uterine incisionhealingduring the second cesarean section,in order to provide a basis for the clinical prevention of cesarean scar diverticulum.Methods:76 patients who found obvious lower uterine muscular defect during the second cesarean section from January 2018 to December 2019 were analyzed.46 patients who underwent the lower uterine reinforcement suture were used as the observation group.30 patients without the lower uterine reinforcement suture served as the control group.The operation time,intraoperative blood loss,urinary catheter indwelling time,hospitalization time,fever rate 3 days after operationand postoperative bloody lochia duration of the two groups were recorded and statistic analyzed.42 days after the operation,transvaginal ultrasound was performed to assess the healing of uterine incision.the cases of poor healing of uterine incisions,the size of the liquid dark area,the thickness of the residual myometrium,the length of the uterus and the position of the uterus were statistic analyzed.Menstrual recovery was followed up for 2 years after operation.patients with menstrual abnormalities or poor healing of the uterine incision about 42 days after operation,were reperformed by transvaginal ultrasound.Necessarily,Hysteroscopy was used to determine whether there was cesarean scar diverticulum.Results:1.There was no statistical difference between the observation and control groups in age,gestational week,BMI before operation and newborn birth weight(P>0.05).The two groups of patients were comparable.2.There was no significant difference between the observation group and the control group in operation time,intraoperative blood loss,urinary catheter indwelling time,fever rate 3 days after operationand hospitalization time(P>0.05).In the two groups,no one happened bladder rupture,urine retention,urinary tract infection,puerperal infection,etc.However,the average duration of postoperative bloody lochia in the observation group(11.52±5.00d)was shorter than that of the control group(15.70±7.24d),and the difference was statistically significant(P<0.05).3.42 days after the operation,transvaginal ultrasound was performed to assess the healing of uterine incision.The incidence of poor healing of uterine incisions in the observation group was lower than that in the control group(20%vs 43%),and the length and width of the liquid dark zone were shorter than those in the control group(10.75±4.53mm,8.25±3.41mm vs15.000±3.24mm,11.77±2.68mm).The residual myometrium in the conservation group was thicker than that in the control group(6.16±0.35mm vs 3.15 ±0.74mm).all the difference were statistically significant(P<0.05).There was no significant difference in uterine length and uterine position between the two groups(P>0.05).4.Menstrual recovery:The incidence of menstrual abnormalities in the observation group(9%,4/46)was lower than the control group(27%,8/30),and the difference was statistically significant(P<0.05).2cases in each group was menstrual abnormalities,but was not the formation of cesarean scar diverticulum.5.CSD formation in patients with poorly healed uterine incision 1 or 2 years after operation:In the observation group,9 patients with poorly healed uterine incision underwent transvaginal ultrasound examination,and 5 patients were found CSD(56%,5/9).In the control group,13 patients with poorly healed uterine incision underwent transvaginal ultrasound examination,and 10 cases were found CSD(77%,10/13).In the two groups,the incidence of CSD in patients with poorly healed uterine incisions was 68%(15/22)1 or 2 years after operation.Compared with the control group,patients with poorly healed uterine incision in the observation group had a lower incidence of CSD 1 or 2 years after operation(56%vs 77%),but the difference was not statistically significant(P>0.05).In the observation group,the residual muscle thickness of CSD patients was thicker than that of the control group(6.90mm vs 4.01mm),and the CSD length was shorter than that of the control group(11mm vs 15mm),and the differences were statistically significant(P<0.05).Between the two groups,the CSD width difference was not statistically significant(P>0.05).Conclusion:1.The lower uterine reinforcement suture is easy to operate,does not increase intraoperative blood loss,and does not cause surgical complications.It is simple,safe and easy to perform.2.The lower uterine reinforcement suture can increase the thickness of the lower uterine muscle,which can not only improve the blood flow of the uterine incision,but also better resist the traction of the uterine contraction,which is beneficial to the uterine incision.heal.3.Transvaginal ultrasound is used to evaluate the healing of the uterine incision in patients with re-cesarean section about 42 days after operation,which has certain value in predicting the formation of cesarean scar diverticulum.Based on the results,we can perform early intervention and treatment.4.This article is a retrospective study,and it is impossible to dynamically monitor the myometrial thickness of the uterine incision and the occurrence of CSD in all patients 1 or 2 years after operation.Further research is needed.