文章摘要
郑丹丹,盛少琴,俞蕾媛,等.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[J].浙江中医药大学学报,2021,(2):179-184.
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
Clinical Study of Sanqi Chonglou Shenghua Decoction Combined with Uterine Scar Resection for Preventing Previous Cesarean Scar Defect in Second Cesarean Section
投稿时间:2020-07-03  
DOI:10.16466/j.issn1005-5509.2021.02.015
中文关键词: 三七重楼生化汤  子宫瘢痕切除术  子宫切口憩室  异常子宫出血  残余肌层厚度  憩室容积
英文关键词: Sanqi Chongou Shenghua Decoction  uterine scar resection  previous cesarean scar defect  abnormal uterine bleeding  residual myometrial thickness  diverticulum volume
基金项目:浙江省中医药科技计划重点资助项目(2018ZZ013)
作者单位E-mail
郑丹丹 三门县人民医院 浙江三门 317100  
盛少琴 浙江中医药大学附属第二医院 shshaoqin@sina.com 
俞蕾媛 浙江中医药大学附属第二医院  
范梦梦 浙江中医药大学附属第二医院  
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中文摘要:
      [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,治疗组b在治疗组a基础上加以三七重楼生化汤口服。观察比较三组患者的术前资料、术后一般情况。术后第42天、6个月、1年复查经阴道超声,观察子宫切口愈合情况,分别统计三组患者剖宫产术后发生PCSD的例数,以及子宫残余肌层厚度、憩室容积。术后1年对患者的月经情况进行随访,观察异常子宫出血(abnormal uterine bleeding,AUB)的发生情况。[结果]与对照组比较,治疗组a的平均每日宫底下降高度增加,而血性恶露持续时间、子宫收缩痛评分减低(P<0.05);治疗组b的平均每日宫底下降高度增加,而术后最高体温、血性恶露持续时间、子宫收缩痛评分、白细胞计数、C反应蛋白水平均减低(P<0.05)。治疗组间比较,治疗组b患者的术后最高体温、血性恶露持续时间、白细胞计数、C反应蛋白水平均低于治疗组a(P<0.05)。对照组、治疗组a、治疗组b术后发生PCSD例数分别为10例、4例、2例(P<0.05)。与对照组比较,两个治疗组术后第42天、6个月、1年测得的子宫残余肌层厚度、憩室容积均有好转(P<0.05);与治疗组a比较,治疗组b术后第42天憩室容积明显减小(P<0.05),术后1年子宫残余肌层厚度增加(P<0.05)。对照组、治疗组a、治疗组b术后1年发生AUB的例数分别为16例、7例、3例,经后点滴出血的例数分别为10例、3例、3例(P<0.01,P<0.05)。与对照组比较,两个治疗组的经期天数、经后出血天数均减少(P<0.05);与治疗组a比较,治疗组b的经期天数明显减少(P<0.05),但经后出血天数未见明显减少(P>0.05)。[结论]三七重楼生化汤联合二次剖宫产术中子宫瘢痕切除能降低术后PCSD的发生率,并能减少AUB的发生。
英文摘要:
      [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.
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