臨床婦人科産科76巻12号

2022年12月発行

今月の臨床 帝王切開分娩のすべて―この1冊でわかるNew Normal Standard 術式の工夫

子宮筋層縫合術の工夫―縫合不全・瘢痕部菲薄化の予防のために

著者： 小谷友美¹ 牛田貴文¹

所属機関： ¹名古屋大学医学部附属病院総合周産期母子医療センター

ページ範囲：P.1196 - P.1201

●伸展した子宮壁の縫合では菲薄化リスクが高いことを認識する．

●脱落膜には針をかけ，脱落膜を創部に陥入させないようにする．

●創部の厚みの違いを認識し，薄く広がる足側の運針に留意する．

●barbed suture糸による無結紮法が普及しつつある．

参考文献

1）Antila-Långsjö RM, et al : Cesarean scar defect : a prospective study on risk factors. Am J Obstet Gynecol 219 : 458.e1-458.e8, 2018

2）炭竈誠二，他 : 帝王切開後の子宮前壁楔状欠損と筋層菲薄化に関する検討．産婦の実際62 : 719-724, 2013

3）Hayakawa H, et al : Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography. Acta Obstet Gynecol Scand 85 : 429-434, 2006

4）Stegwee SI, et al : Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes : a systematic review and meta-analysis. BJOG 125 : 1097-1108, 2018

5）Sumigama S, et al : Uterine sutures at prior caesarean section and placenta accreta in subsequent pregnancy : a case-control study. BJOG 121 : 866-874 ; discussion 875, 2014

6）Di Spiezio Sardo A, et al : Risk of Cesarean scar defect following single- vs double-layer uterine closure : systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol 50 : 578-583, 2017

7）Raischer HB, et al : Knotless barbed versus conventional suture for closure of the uterine incision at Cesarean delivery : a systematic review and meta-analysis. J Minim Invasive Gynecol 29 : 832-839, 2022

8）Maki J, et al : The Spiral Trial : A multicenter, randomized, controlled trial of Spiral thread sutures versus conventional thread sutures to prevent thinning of uterine scars following elective cesarean section. Contemp Clin Trials 107 : 106449, 2021

9）Uccella S, et al : Incidence and prevention of vaginal cuff dehiscence after laparoscopic and robotic hysterectomy : a systematic review and meta-analysis. J Minim Invasive Gynecol 28 : 710-720, 2021

10）Dodd JM, et al : Surgical techniques for uterine incision and uterine closure at the time of caesarean section. Cochrane Database Syst Rev （7）: CD004732, 2014