阴式手术与宫腹腔镜联合手术治疗剖宫产术后子宫切口憩室的效果观察  

Curative effect of vaginal operation and hysteroscopy combined with laparoscopy on previous cesarean scar defect diverticulum after cesarean section

作　　者：马菊花[1] Ma Juhua(Department of Obstetrics, Laizhou People＇ s Hospital, Laizhou 261400, China)

机构地区：[1]山东省莱州市人民医院产科,261400

出　　处：《中国实用医刊》2017年第19期53-55,共3页Chinese Journal of Practical Medicine

摘　　要：目的比较阴式手术和宫腹腔镜联合手术治疗剖宫产术后子宫切口憩室的临床效果。方法选择50例剖宫产术后子宫切口憩室患者并随机分为两组，宫腹腔镜组给予宫腹腔镜联合手术，阴式组给予阴式手术。比较两组患者手术期间相关临床指标、术后随访情况与不良事件发生率。结果宫腹腔镜组术中出血量[（84.65±14.68）ml]、术后阴道出血时间[（7.90±1.88）d]与住院时间[（5.61±2.38）d]少于阴式组[（111.58±24.65）ml、（9.67±2.05）d、（8.84±3.15）d]，手术时间[（117.89±38.56）min]与医疗费用[（15 776.51±7 980.49）元]多于阴式组（[（67.45±21.48）min、（5 897.10±861.47）元]；术后不良事件发生率（20%）低于阴式组（68%），差异有统计学意义（P〈0.01）。两组患者肛门排气时间、术后随访经期恢复与憩室修复情况比较差异未见统计学意义（P〉0.05）。结论阴式手术和宫腹腔镜联合手术在剖宫产术后子宫切口憩室治疗中均有显著疗效，而宫腹腔镜联合手术围术期创伤更小，不良事件更少，但医疗费用昂贵，具有借鉴意义。Objective To compare the clinical efficacy of vaginal surgery and that of hysteroscopy combined with laparoscopy on patients with previous cesarean scar defect （PCSD）. Methods Fifty patients with PCSD were randomly divided into two groups. Patients in the hysteroscopy and laparoscopy group underwent hysteroscopy combined with laparoscopy, while patients in the vaginal group were treated by transvaginal surgery. The clinical indexes, postoperative follow-up and incidences of adverse events were compared between the two groups. Results The intraoperative blood loss [ （84. 65 ± 14. 68）ml], vaginal bleeding time [ （7.90 ± 1.88）d] and hospitalization time [ （5.61 ± 2. 38）d] in the hysteroseopy combined with laparoscopy group were significantly lower than those in the vaginal group [（111.58 ±24.65）ml,（9.67 ±2.05）d,（8.84±3. 15）d] ;theoperationtime[（117.89±38.56）mini and medical expenses [ （15 776.51 ± 7 980.49） yuan] were significantly higher than those in the vaginal group [ （67.45 ± 21.48）min, （5 897.10 ± 861.47）yuan] ; the overall incidence of adverse events in the hysteroscopy combined with laparoscopy group （20%） was lower than that in the vaginal group（68% ）, there was a statistically significant difference （P 〈0. 01 ）. There was no statisti- cally significant difference in anal exhaust time, recovery of menstrual period and diverticulum repair followed up after operation between the two groups （P 〉 0.05 ）. Conclusions The vaginal surgery and hysteroscopy combined with laparoscopy both have significant theraputic effect on PCSD. Hysteroscopy combined laparoscopy has less trauma in perioperative period, and less adverse events, but has expensive medical expenses, which is worth for reference.

关 键 词：阴式手术 宫腹腔镜联合手术 子宫切口憩室 阴道出血 

分 类 号：R719.8[医药卫生—妇产科学]