宫腹腔镜下瘢痕切除修补术与雌孕激素治疗剖宫产切口憩室效果比较  

Efficacy comparison of two different treatments to cesarean section scar diverticulum:scar excision and repair by laparoscopy combined hysteroscopy and progesterone cycle therapy

作　　者：武欣[1] 林如[1] 袁英[1] 何以丰[2] 徐丛剑[1] 胡卫国[1] 薛晓红[1] 汪清[1] 

机构地区：[1]复旦大学附属妇产科医院,上海200011 [2]上海交通大学医学院附属仁济医院妇产科,上海200127

出　　处：《中国实用妇科与产科杂志》2013年第11期898-901,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：上海市卫生局青年科学基金(20114Y058);上海市自然科学基金(13ZR1403300);国家自然基金青年科学基金(81302259)

摘　　要：目的将宫腹腔镜下剖宫产切口瘢痕切除修补术治疗剖宫产切口憩室与雌孕激素周期治疗对比，探讨其临床价值。方法自2009年2月到2012年1月，收集至复旦大学附属妇产科医院就诊的剖宫产切口憩室患者145例，分别采用宫腹腔镜下剖宫产切口瘢痕切除修补术和雌孕激素周期治疗（分别设为研究组、对照组）。对患者治疗前后阴道出血、切口愈合等进行统计学分析。结果研究组患者术后切口愈合良好者占73．5％，每月阴道出血时间≤7d占38．8％，8～14d占51．0％，月经量减少至正常者占24．5％，超声提示切17完全愈合占73．5％，明显缩小占20．4％，无明显变化占6．1％。对照组治疗后每月阴道出血时间≤7d占8．5％，8—14d占44．7％，月经量减少至正常者占4．3％，切口缺损无明显变化。两组间各项差异有统计学意义（P〈0．01）。两组间下腹疼痛改善情况差异无统计学意义（P〉0．05）。结论宫腹腔镜下剖宫产切口瘢痕切除修补术的有效性和治疗彻底性均明显优于传统雌孕激素周期治疗，值得推广应用。Objective The surgical approach scar excision and repair by laparoscopy combined hysteroscopy has been carried out and achieved good results. This study compared it with estrogen and progesterone cycle therapy to explore the value of it. Methods Between February 2009 and January 2012, the 145 patient in Obstetrics and Gynecology Hospital of Fudan University has been collected and been divided into laparoseopy combined hysteroscopy group and the estrogen and progesterone cycle therapy group. The improvement of vaginal bleeding and wound healing situation etc were analyzed. Results The rate of incision healing well in the study group after surgery accounted for 73.5%, and the patients monthly vaginal bleeding time ≤7 days accounted for 38.8% , and that for g - 14 days accounted for 51.0%. The patients menstruation returned to normal accounted for 24. 5%. The patients incision completely healed accounted for 73.5%, and that significantly reduced and no change were 20.4% and 6. 1% respectively. In control group monthly vaginal bleeding time ≤ 7 days and 8 - 14 days were observed in only 8. 5% and 44.7% of patients respectively; The patients menstruation returned to normal accounted for 4. 3%. Incision defect of patients had no significant improvement. The differences between two groups were significant（ P 〈 0. 01 ）. But the difference of abdominal pain between the two groups was not significant （P 〉 0. 05）. Conclusion The effectiveness and thoroughness of the surgery were significantly higher than estrogen and progesterone cycle therapy, so the method should be widely applied.

关 键 词：剖宫产切口憩室 宫腹腔镜联合手术 雌孕激素周期治疗 

分 类 号：R713.4[医药卫生—妇产科学]