3种手术方式治疗剖宫产术后子宫瘢痕憩室的临床疗效对比及评价被引量：39

Comparison and evaluation of the clinical effects of 3 surgical methods for uterine scar diverticulum after cesarean section

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摘要目的探讨3种手术方式治疗剖宫产术后子宫瘢痕憩室(previous cesarean scar defect,PCSD)的临床疗效及最佳手术方式。方法回顾性分析2016年11月至2018年11月深圳市龙华区人民医院收治的62例剖宫产术后PCSD患者的临床资料,根据手术方式进行分组,其中行经阴道切口憩室修补术23例为A组,行宫腔镜电切术18例为B组,行宫腹腔镜联合手术21例为C组。比较3组患者手术时间、术中出血量、术后肛门排气时间、术后住院时间、术后月经改善及切口憩室恢复情况,分析和评价最佳手术方式。结果A组和B组手术时间[(40.0±13.2)min、(35.0±12.3)min]短于C组[(80.0±10.2)min],A组和C组术中出血量[(45.0±8.5)mL、(50.0±7.4)mL]多于B组[(5.08±1.6)mL],A组和C组术后肛门排气时间[(6.0±2.3)d、(6.6±2.1)d]及住院时间[(5.0±1.4)d、(5.2±1.3)d]均长于B组[(2.8±1.3)d、(2.1±1.1)d],差异均有统计学意义(P<0.05);A组、C组、B组术后月经改善有效率分别为91.3%、90.5%、55.6%,A组、C组、B组术后憩室恢复有效率分别为87.0%、90.5%、33.3%,A组和B组比较,B组和C组比较差异有统计学意义(P<0.05),A组、C组比较差异无统计学意义(P>0.05)。结论3种手术方式临床上各有优势,但经阴道切口憩室修补术和宫腹腔镜联合手术临床疗效较宫腔镜电切术明显,因此应根据患者具体情况及要求,选择最佳手术方式。 Objective To explore the clinical effects and the best surgical methods of 3 surgical methods for the treatment of previous cesarean scar defect(PCSD).Methods The clinical data of 62 patients with PCSD after cesarean section from November 2016 to November 2018 in Shenzhen Longhua District People's Hospital were retrospectively analyzed and grouped according to surgical methods.Among them,23 cases underwent transvaginal incision diverticulum repair.In group A,18 cases underwent hysteroscopic electroresection were group B,and 21 cases underwent hysteroscopy combined with laparoscopy in group C.The operation time,intraoperative blood loss,postoperative anal exhaust time,postoperative hospital stay,postoperative menstrual improvement and incision diverticulum recovery of the three groups were compared,and the best surgical method was analyzed and evaluated.Results The operation time of group A and group B[(40.0±13.2 min,(35.0±12.3)min]was shorter than that of group C[(80.0±10.2)min],the intraoperative blood loss of group A and group C[(45.0±8.5)mL,(50.0±7.4)mL]was more than in group B[(5.08±1.6)mL],the postoperative anal exhaust time in groups A and C is[(6.0±2.3)d,(6.6±2.1)d],and the length of hospital stay[(5.0±1.4)d,(5.2±1.3)d]were longer than group B[(2.8±1.3)d,(2.1±1.1)d],the differences were statistically significant(P<0.05);group A,group C,group B menstrual improvement effective rate were 91.3%,90.5%,and 55.6%,and the effective rates of postoperative diverticulum recovery in groups A,C,and B were 87.0%,90.5%,and 33.3%,respectively.The differences between group A and group B,group B and group C were statistically significant(P<0.05)There was no significant difference between group A and group C(P>0.05).Conclusion Each of the three surgical methods has its own clinical advantages,but the clinical efficacy of the transvaginal group and hysteroscopy group is more obvious than that of the hysteroscopy group.Therefore,the best surgical method is selected according to the patient's specific conditions and requirements.

作者夏伟兰刘冰王伶俐季新梅 XIA Weilan;LIU Bing;WANG Linli;JI Xinmei(Department of Gynecology,Shenzhen Longhua District People's Hospital,Shenzhen Guangdong 518100,P.R.China)

机构地区深圳市龙华区人民医院妇科

出处《中国计划生育和妇产科》 2020年第6期79-81,86,共4页 Chinese Journal of Family Planning & Gynecotokology

关键词剖宫产术后子宫瘢痕憩室宫腔镜手术宫腹腔镜手术阴式手术疗效对比 previous cesarean scar defect hysteroscopy hysteroscopy combined with laparoscopy transvaginal uterine scar diverticulum resection

分类号 R713 [医药卫生—妇产科学]

作者简介夏伟兰,毕业于南方医科大学,硕士,副主任医师,主要研究方向为妇产科;通讯作者:季新梅,E-mail:mdjjxm@163.com。

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