Investigation Of The Correlation Between Uterine Scar Diverticulum Patients’ Symptoms And Their TCMC

ObjectiveTo investigate the distribution characteristics of Traditional Chinese Medicine Constitution（TCMC）in patients with previous cesarean scar defect（PCSD）and the correlation between symptoms and TCMC.And the relationship between the structure of PCSD and the prolonging of menstruation and TCMC.MethodsThe object of study for the period September 2016 to February 2019 to the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine of gynecological is outpatients and inpatients with PCSD.The patients conform to the diagnostic criteria of PCSD and the criteria of the study are 169 cases.All patients were classified according to the TCMC Classification and Determination Questionnaire.Patients age,the disease of time,number of cesarean sections,period before cesarean section,clinical symptoms（Patients’ menstrual period,chronic pelvic pain,uterine scar pregnancy,secondary dysmenorrhea）,uterine color Doppler ultrasound results（volume of PCSD,deep,wide,high,the Residual myometrial thickness（RMT）of PCSD at its thinnest part）and TCMCwere recorded.SPSS 20.0 software was used for data analysis.All measurements were expressed by mean plus minus standard deviation（x+s）.The mean comparison between the two groups,using independent sample t/t’ test.First,homogeneity of variance F test was performed,such as homogeneity of variance,t test,such as variance uneven,was used instead of t’ test;all non-normal distribution measurements were expressed by quartile（P25,P50,P75）;and non-parametric test was used for comparison.Chi-square test and Fisher₂（exact probability method）were used to test four-square test.Non-conditional Logistic regression analysis was used to analyze the correlation between the prolongation of menstrual period of PCSD and the result of 3D uterine color Doppler ultrasound of PCSD and the common TCM contitution.P<0.05 was considered statistically significant.Results1.The results of this study showed that the TCMC type of 169 patients with PCSD had distribution differences（P<0.01）.There was 34.91%（59/169）patients had Qi deficiency,followed by Qi depression 23.08%（39/169）,Yang deficiency consisted 17.16%（29/169）of all patients,Dampness-heat contributed 11.83%（20/169）,There was 5.92%（10/169）,4.14%（7/169）,2.37%（4/169）,and 0.59%（1/169）patients developed Yin Deficiency,blood stasis,phlegm-dampness and Plain TCMC,respectively.While the age,number of sections,period before cesarean section,uterus position had little effect on the distribution of constitution type.2.In these 169 patients with PCSD showed,26.62%（45/169）had normal menstruation（<7 days）,Qi depression 31.11%（14/45）.73.37%（124/169）had prolonged menstruation（>7 days）,Qi deficiency 37.09%（46/124）.Then normal menstruation（>7 days）and prolonged menstruation（>7 days）had a significant difference between different groups（P<0.05）.The Qi deficiency,damp-heat TCMC was significantly higher in prolonged menstruation patients than that ofYin Deficiency.22.48%（38/169）had chronic pelvic pain,in which Qi deficiency and damp-heat TCMC accounted for 21.05%（8/38）,Chronic pelvic pain（no）group of 131 patients,accounting for 77.51%（131/169）,in which Qi deficiency accounted for 38.93%（51/131）.The difference between the two groups had a significant difference（P<0.05）.The damp-heat TCMC was significantly in chronic pelvic pain higher than Qi depression.There was 30 patients with secondary dysmenorrhea（yes）accounting for 17.75%（30/169）,among which 50%（15/30）were with Qi depression.And 82.24Yo（139/169）patients with secondary dysmenorrhea（no）,in which Qi deficiency accounted for 34.53%（48/139）.The difference between the two groups had a significant difference（P<0.05）.The Qi depression was significantly in chronic pelvic pain higher than Yang deficiency.There was no statistical significance between the uterine scar pregnancy and TCMC type.3.The correlation between the common TCMC and the structure of PCSD was found:Qi deficiency were correlated with the（P=0.002、OR=0.386）,Qi depression were correlated with the width（P=0.017、OR=1.094）and and heiht（P=0.018、OR=0.809）of the PCSD,Yang deficiency were correlated with the height（P=0.003、OR=1.275）andRMT（P=0.002、OR=2.051）of the PCSD,while there was no significant correlation between damp-heat TCMC and diverticulum（P>0.05）·4.And normal menstruation group and prolonged menstruation group RMT of PCSD average value were 2.85（2.12,3.40）mm and 4.00（2.50,4.55）mm,respectively.There was significant difference in RMT between the two groups（P<0.05）.The volume of the prolonged menstruation group and normal menstruation groupwere 0.54（0.22,0.98）mland 0.22（0.07,0.45）ml.There was significant difference in volume between the two groups（P<0.05）.The wider the PCSD（P=0.000,OR=1.312）,and the RMT was（P=0.006,OR=0.592）,the longer the menstrual cycle was more likely to occur.Conclusion:The results of this study show that the common TCMC of PCSD were Qi deficiency,Qi depression,Yang deficiency,damp-heat TCMC.The most common clinical symptoms of PCSD are prolonged menstruation after cesarean seation,hronic pelvic pain and dysmenorrhea.The Qi deficiency,damp-heat TCMC was significantly higher in prolonged menstruation patients than that of Yin Deficiency.The damp-heat TCMC was significantly in chronic pelvic pain higher than Qi depression.The Qi depression was significantly in chronic pelvic pain higher than Yang deficiency.The common TCMC of PCSD has certain correlation with the structure of the diverticulum,Qi deficiency are associated with RMT of diverticulum,the thinner the RMT,the more likely the patients are Qi deficiency.Qi depression are closely related to the width and height of the PCSD.When the width is larger and the height is small of the diverticulum,the patient is more likely to Qi depression.Yang deficiency were correlated with the height,RMT of PCSD.The higher the height and the thicker the RMT of the diverticulum,the more likely the patient is to Yang deficiency.Prolonged menstruation is related to the width,RMT and diverticulum volume.