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
- VernacularTitle: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形成的相关因素分析
- Author:
Meng CHEN
1
;
Kegong CHEN
;
Huanhuan LI
Author Information
1. 华东师范大学附属芜湖医院芜湖市第二人民医院妇产科,安徽芜湖 241000
- Keywords:
Myometrium;
Caesarean section;
Cesarean scar diverticulum;
Three-layer suture;
Double suture
- From:
Journal of Practical Obstetrics and Gynecology
2024;40(5):398-404
- CountryChina
- Language:Chinese
-
Abstract:
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.
