三七重楼生化汤联合子宫瘢痕切除术预防二次剖宫产子宫切口憩室的临床研究

[目的]探讨三七重楼生化汤联合二次剖宫产术中子宫瘢痕切除对预防子宫切口憩室(previous cesarean scar defect,PCSD)形成的作用.[方法]按照纳入标准,选取行二次子宫下段剖宫产的孕妇150例,按入院顺序随机分为3组,对照组行常规子宫下段横切口剖宫产术,治疗组a在剖宫产术中行子宫瘢痕切除,治疗...

Clinical Study of Sanqi Chonglou Shenghua Decoction Combined with Uterine Scar Resection for Preventing Previous Cesarean Scar Defect in Second Cesarean Section

[Objective]To explore the effect of Sanqi Chonglou Shenghua Decoction combined with uterine scar resection in second cesarean section on the prevention of previous cesarean scar defect(PCSD). [Methods] A total of 150 pregnant women who underwent the second cesarean section that met the inclusion criteria were selected and randomly divided into 3 groups according to the order of admission. Patients in control group were given a conventional lower uterine section incision cesarean section, patients of treatment group a were treated with uterine scar resection in second cesarean section, and treatment group b were given Sanqi Chonglou Shenghua Decoction on the basis of treatment group a. The preoperative data and general postoperative conditions of the three groups were collected and observed. At the 42nd day, 6 months and 1 year after operation, transvaginal ultrasound was reexamined to observe the healing of uterine incision, and the number of cases of PCSD was counted, as well as the residual myometrial thickness and diverticulum volume of the uterus. One year after operation, the menstrual condition of the patients was followed up to observe the occurrence of abnormal uterine bleeding(AUB). [Results]Compared with control group, the average daily fundus drop height of treatment group a was higher, while the bloody lochia duration and uterine contraction pain score were lower(P<0.05);the average daily fundus drop height of treatment group b was higher, and the postoperative maximum body temperature, blood lochia duration, uterine contraction pain score, white blood cell count, and C reactive protein level were lower(P<0.05). Comparison between the treatment groups showed that the postoperative maximum body temperature and blood lochia duration, white blood cell count, and C reactive protein level of treatment group b were all lower than that of treatment group a(P<0.05). The numbers of PCSD cases in control group, treatment group a and treatment group b after operation were 10, 4, and 2, respectively, and the difference was statistically significant(P<0.05). Compared with control group, the thickness of the residual myometrium and the volume of the diverticulum measured at the 42nd day, 6 months, and 1 year after operation in two treatment groups improved(P<0.05);compared with treatment group a, the volume of the diverticulum of treatment group b measured on the 42nd day was significantly reduced(P<0.05), and the thickness of the residual myometrium of the uterus measured 1 year after operation increased(P<0.05).The numbers of cases of AUB in control group, treatment group a and treatment group b1 year operation were 16, 7, and 3, respectively, and the numbers of cases of postmenstrual spotting were 10, 3, and 3,respectively, the difference was statistically significant(P<0.01,P<0.05). Compared with control group, the menstrual days and bleeding days after menstruation of two treatment groups were reduced(P<0.05);compared with treatment group a, the menstrual days of treatment group b were significantly reduced(P<0.05), but there was no significant decrease in bleeding days in treatment group b, there was no significant reduction in the number of days after bleeding, and the difference was not statistically significant(P>0.05).[Conclusion]Sanqi Chonglou Shenghua Decoction combined with uterine scar resection during the second cesarean section can reduce the incidence of postoperative PCSD and reduce the incidence of AUB.