Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
1
admin
1683-1764
1735-7322
10.18869/acadpub.tumj
000
000
000
fa
jalali
1403
4
1
gregorian
2024
7
1
82
4
online
1
fulltext
other
بررسی ارتباط نقص اسکار سزارین با آدنومیوز در بیماران با خونریزی غیرطبیعی
Association between cesarean scar defect and adenomyosis
in patients with abnormal uterine bleeding
مقاله اصیل
Original Article
<span style="font-family:yekanYW;"><span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">زمینه و هدف:</span></span></i></b><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> اخیرا شیوع جراحی سزارین </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">(Cesarean section, CS)</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> بهطور چشمگیر افزایش پیدا کرده است. نقص اسکار سزارین </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">(Cesarean scar defect, CSD)</span></span><span style="font-size:10.0pt"><span style="line-height:102%"> یکی از شایعترین عوارض </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">CS</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> میباشد. هدف این مطالعه، بررسی و مقایسه عمق و حجم </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">CSD</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"> در بیماران علامتدار با و بدون آدنومیوز میباشد.</span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">روش بررسی:</span></span></i></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">این مطالعه بهصورت گذشتهنگر و مورد- شاهدی در بازه زمانی دو سال (آذر 1399 تا آذر 1401) طراحی شده است. بیماران علامتدار دارای معیارهای ورود به دو گروه تقسیم</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">بندی شدند: با آدنومیوز (گروه مورد) و بدون آدنومیوز (گروه شاهد). دادههای دموگرافیک بیماران، سوابق پزشکی و یافته های سونوهیستروگرافی از مدارک بیماران و تصاویر بایگانی شده استخراج شد.</span></span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:102%"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><i><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">یافتهها:</span></span></i></b> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">در طول دو سال، از بین </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">۳۱۰</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> خانم علامتدار با سابقه سزارین که تحت سونوهیستروگرافی قرار گرفتند، </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">۱۶۰</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> بیمار دارای معیارهای ورود (گروه مورد: </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">۸۲</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> بیمار و گروه شاهد: </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">۷۸</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> بیمار) بودند. شکایت اصلی، خونریزی پس از قاعدگی (</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">8/%43)</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">، قاعدگی طولانیمدت (</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">3/%34) </span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">و خونریزی بین قاعدگی (9/21</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">%) </span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">بود. عمق و حجم </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">CSD</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> در بیماران دارای آدنومیوز بهطور معناداری بالاتر اندازهگیری شد (بهترتیب با </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">P-value</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> های </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">002/0</span></span> <span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">و </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">038/0). </span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">همچنین </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">RMT</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> و نسبت </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">RMT/AMT</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> در بیماران دارای آدنومیوز بهطور قابلتوجهی پایین</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%"></span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%">تر دیده شد (بهترتیب با </span></span><span dir="LTR" style="font-size:8.0pt"><span style="line-height:102%">P-value</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> های </span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">004/0</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"> و</span></span><span lang="FA" style="font-size:10.0pt"><span style="line-height:102%">00/0).</span></span><span lang="AR-SA" style="font-size:10.0pt"><span style="line-height:102%"><span style="font-family:"B Lotus""></span></span></span></span></span></span></span><br>
<b><i><span dir="RTL" lang="FA" style="font-size:10.0pt">نتیجهگیری:</span></i></b> <span dir="RTL" lang="AR-SA" style="font-size:10.0pt">مطالعهی ما ارتباط قوی بین آدنومیوز و سایز بزرگتر </span><span style="font-size:8.0pt">CSD</span><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"> را نشان داد. برای اثبات رابطه علت و معلولی، مطالعات آینده</span><span dir="RTL" lang="FA" style="font-size:10.0pt"></span><span dir="RTL" lang="AR-SA" style="font-size:10.0pt">نگر برای پیگیری بیماران پس از اولین سزارین جهت مقایسه و بررسی تشکیل </span><span style="font-size:8.0pt">CSD</span><span dir="RTL" lang="AR-SA" style="font-size:10.0pt"> در موارد با و بدون آدنومیوز پیشنهاد میشود.</span></span>
<div><span style="font-size:12pt"><span style="line-height:130%"><span new="" roman="" style="font-family:" times=""><b><i><span style="font-size:10.0pt"><span style="line-height:130%">Background:</span></span></i></b><span style="font-size:10.0pt"><span style="line-height:130%"> The prevalence of cesarean section (CS) has recently increased dramatically. Cesarean scar defect (CSD) is one of the most common complications of CS. This study aims to investigate and compare the depth and volume of the CSD in symptomatic patients with and without uterine adenomyosis.</span></span></span></span></span><br>
<span style="font-size:12pt"><span style="line-height:130%"><span new="" roman="" style="font-family:" times=""><b><i><span style="font-size:10.0pt"><span style="line-height:130%">Methods:</span></span></i></b><span style="font-size:10.0pt"><span style="line-height:130%"> <span style="letter-spacing:-.2pt">This retrospective case-control study was done from November 2020 to November 2022 at our referral women's hospital. The patients who underwent sonohysterography with a previous history of one or two CS for at least one year ago and chief complaints of abnormal uterine bleeding were included in our study. The patients with myometrial or endometrial pathology were excluded from the study. The symptomatic patients who met the inclusion criteria were divided into two groups: with adenomyosis (case) and without adenomyosis (control). The demographic data, medical history, and sonohysterography findings were obtained from the patient’s documents and archived images. In sonohysterography, CSD features, including the length, depth, width, volume, RMT (Remained Myometrial Thickness), AMT (Adjacent Myometrial Thickness), and RMT/AMT were measured. To analyze the variables, t-tests, and chi-square were used.</span></span></span></span></span></span></div>
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<div><span style="font-size:12pt"><span style="line-height:130%"><span new="" roman="" style="font-family:" times=""><b><i><span style="font-size:10.0pt"><span style="line-height:130%">Results:</span></span></i></b><b> </b><span style="font-size:10.0pt"><span style="line-height:130%"><span style="letter-spacing:-.2pt">Among 310 symptomatic women with a history of previous cesarean section underwent sonohysterography, 160 patients met the inclusion criteria (case group with adenomyosis: 82 patients and control group without adenomyosis: 78 patients). The chief complaints were post-menstrual bleeding (43.8%), prolonged bleeding (34.3%), and intermenstrual bleeding (21.9%). In the case group, 25.6% had CSD with RMT<2mm, but in the control group (without adenomyosis), only 6.4% had RMT<2mm. CSD depth and volume were significantly larger in patients with underlying adenomyosis (P-value of 0.002 and 0.038, respectively). Also, the mean RMT and RMT/AMT ratio were significantly lower in the case group (P-values of 0.004 and 0.00, respectively).</span></span></span></span></span></span></div>
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<div><span style="font-size:12pt"><span style="line-height:130%"><span new="" roman="" style="font-family:" times=""><b><i><span style="font-size:10.0pt"><span style="line-height:130%">Conclusion:</span></span></i></b><span style="font-size:10.0pt"><span style="line-height:130%"> Our study demonstrated a strong association between the presence of adenomyosis and larger CSDs. To establish a causative relationship, we suggest a prospective cohort study to follow up the patients and compare the evolution of CSD in patients with and without adenomyosis.</span></span></span></span></span></div>
آدنومیوز, سزارین, سونوگرافی, رحم.
adenomyosis, cesarean section, ultrasound, uterus.
299
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http://tumj.tums.ac.ir/browse.php?a_code=A-10-3666-804&slc_lang=other&sid=1
Fatemeh
Shakki Katouli
فاطمه
شکی کتولی