Abstract: Objective To investigate the influencing factors and self-healing of cesarean scar defect (CSD). Methods Four hundred and sixty-one cases undergoing cesarean section at term in Qingdao Women and Children's Hospital from January to November 2015 were selected as the subjects. All of them underwent transvaginal color Doppler ultrasonography at 6-8 weeks and 6 months after childbirth. In accordance with the results of the two examinations, they were divided into normal scar group (n=311), suspicious scar defect group (n=102), scar defect group (n=48). And the scar defect group was further assigned to mild scar defect subgroup (n=42) and severe scar defect subgroup (n=6) based on the thickness of residual muscle at the scar defect. The clinical data of all these puerperants were collected for exploring the influencing factors and self-healing of CSD. Results The incidence rate of CSD was 10.4% (48/461) and the healing rate was 68.0% (102/150). The differences in the number of cesarean section and feeding pattern between the normal scar group, suspicious scar defect group and scar defect group were statistical significant (P<0.05), but the difference in gestational weeks at cesarean section was not (P>0.05). The difference in the number of cesarean section between the mild scar defect subgroup and severe scar defect subgroup showed statistical significance (P<0.05), but the differences in gestational weeks at cesarean section and feeding pattern did not (P>0.05). The result of multivariate Logistic regression analysis showed that the number of cesarean section and feeding pattern were the influencing factors of CSD with statistically significant difference (P<0.05). Conclusion There is possibility that CSD will be self-healing in a short period after cesarean section. Repeated cesarean sections and non-exclusive breastfeeding might increase the incidence rate of CSD. Repeated cesarean sections might have relation to the exacerbation of cesarean scar defect.

Key words: Cesarean section, Cicatrix, Root cause analysis, Self-healing

摘要： 目的 探讨剖宫产瘢痕缺陷（CSD）的影响因素及自愈性。方法 选取 2015 年 1—11 月在青岛市妇女儿童医院行足月剖宫产的产妇 461 例。分别于产后 6～8 周和产后 6 个月对相应产妇进行经阴道彩色多普勒超声检查，根据两次检查结果，将纳入产妇分为瘢痕正常组（n=311）、可疑瘢痕缺陷组（n=102）、瘢痕缺陷组（n=48）；根据缺陷处残留肌层厚度，将瘢痕缺陷组进一步分为轻度瘢痕缺陷组（n=42）、重度瘢痕缺陷组（n=6）。收集所有产妇的临床资料，探讨 CSD 的影响因素及自愈性。结果 纳入产妇的 CSD 发生率为 10.4%（48/461），自愈率为 68.0%（102/150）。瘢痕正常组、可疑瘢痕缺陷组、瘢痕缺陷组患者剖宫产次数、喂养方式比较，差异有统计学意义（P<0.05）；剖宫产孕周比较，差异无统计学意义（P>0.05）。轻度瘢痕缺陷组、重度瘢痕缺陷组患者剖宫产次数比较，差异有统计学意义（P<0.05）；剖宫产孕周、喂养方式比较，差异无统计学意义（P>0.05）。多因素 Logistic 回归分析结果显示，剖宫产次数、喂养方式是 CSD 的影响因素，差异有统计学意义（P<0.05）。结论 剖宫产后短期内 CSD 有自愈可能性，多次剖宫产及非纯母乳喂养可增加 CSD 风险，多次剖宫产可能会加重瘢痕缺陷程度。

关键词: 剖宫产术, 瘢痕, 影响因素分析, 自愈