宫腹腔镜联合修补剖宫产术后子宫切口憩室  

Hysteroscopic examination and laparoscopic repair of uterine scar defect after cesarean section

作　　者：丁景新[1] 陈建亮[1,2] 张宏伟[1] 冯炜炜[1] 易晓芳[1] 张旭垠[1] 朱芝玲[1] 张绍芬[1] 华克勤[1] 

机构地区：[1]复旦大学附属妇产科医院妇科,上海200011 [2]杭州萧山第一人民医院妇产科

出　　处：《复旦学报（医学版）》2012年第5期506-510,共5页Fudan University Journal of Medical Sciences

基　　金：国家临床重点专科建设项目(2011-107)~~

摘　　要：目的探讨剖宫产术后子宫切口憩室的可能发生原因及宫腹腔镜联合手术治疗的效果。方法对2009年10月至2011年7月在复旦大学附属妇产科医院住院行宫腹腔镜联合手术修补剖宫产术后子宫切口憩室的14例患者进行回顾性分析和术后随访。结果 14例子宫切口憩室均表现为月经淋漓不净,经期平均为(14.0±4.4)天(8～25天),4例表现为不孕,4例有经期下腹坠痛。术前子宫输卵管造影(hysterosalpinography,HSG)检查憩室宽度平均为(19.3±5.0)mm(13～30mm),深度平均为(11.6±3.2)mm(5～19mm),显著高于阴道超声测量到的宽度和深度(P=0.005,P=0.002)。患者剖宫产手术指征为疤痕子宫(6例)、胎膜早破(3例)、难产(3例)、社会因素(2例)和胎儿窘迫(3例)。术中切口7例缝合1层,4例缝合2层,3例不详。14例患者行宫腹腔镜联合手术修补剖宫产憩室,无中转开腹手术,无术中并发症,无输血病例。平均手术时间为(130±47)min(75～225min),平均出血量为(102±79)mL(30～300mL),术后随访平均4.1月(2～12月)。月经复潮的12例患者除1例外,其余症状均得到改善,经期缩短为(8.6±3.2)天(6～10天),有效率91.7%(11/12)。9例术后2～3个月复查阴道超声,有2例仍有小子宫憩室(分别为6mm×2mm和7mm×5mm)。结论 HSG术前可以更好地评估子宫憩室的大小。再次剖宫产、胎膜早破可能是剖宫产术后子宫切口憩室发生的高危因素。宫腹腔镜联合手术修补子宫切口憩室的有效率高,可以显著改善患者的症状。Objective To explore the possible pathogenesis of uterine scar defect after cesarean section, and to investigate the effect of laparoscopic surgical repair on the defect. Methods Fourteen patients of uterine scar defect after cesarean section who underwent hysteroscopic examination and laparoscopic repair in Obstetrics and Gynecology Hospital of Fudan University since Oct. ,2009 were reviewed retrospectively and followed. Results All the patients had a prolonged period, and the duration was （14.0 ±4.4） days （8- 25 days）, 4 cases had a history of infertility, and 4 cases complained of abdominal pain during menstruation. Hysterosalpingography （HSG） showed the width of the defect was （19.3 ±5.0） mm （13 - 30 mm）, and the depth was （11.6 ±3.2） mm （5 - 19 mm）, both significantly larger than thosed measured by trans-vaginal ultrasonic examination. The indications of cesarean section were uterine scar （previous section, 6 cases） ,premature rupture of fetal membranes （PROM,3 cases）, dystocia （3 cases）, social factor （2 cases） and fetal distress （3 cases）. In the previous cesarean section, the uterine was sutured by I layer of absorbable material in 7 cases, 2 layers in 4 cases, and unknown in the other 3 cases. Repair of the uterine defect was successfully achieved in all 14 patients. There was no intra-operative complications and none of the patients required blood transfusion. The mean operation time was （130 ±47） min （75 - 225 min）, and the mean blood loss was （102 ± 79） mL （30 - 300 mL）. The cases was followed for an average of 4. 1 months （2 - 12 months）. In the 12 patients who had a recovery of menstruation, 11 patients had an obvious shortened period, and the duration was （8.6 ±3.2） days （6 - 10 days） ,and the clinic effective rate was 91. 7% （11/12）. Nine patients had trans-vaginal ultrasonic examination, and small defect was found in 2 patients （6mm× 2mm and 7mm × 5mm, respectively）. Conclusions HSG is better than transvag

关 键 词：剖宫产术后子宫切口憩室 宫腔镜手术 腹腔镜手术 

分 类 号：R713[医药卫生—妇产科学]