宫腔镜联合阴式手术及宫腹腔镜手术治疗子宫切口憩室的疗效分析  

Clinical effects of hysteroscopy combined with vaginal surgery versus hysteroscopy combined with laparoscopy on cesarean section scar diverticulums

作　　者：刘锦钰[1] LIU Jin-yu(Department of Gynecology, Huaibei Maternal and Child Health Hospital, Hnaibei, Anhui 235000, Chin)

机构地区：[1]淮北市妇幼保健院妇科,安徽淮北235000

出　　处：《中华全科医学》2018年第7期1141-1143,共3页Chinese Journal of General Practice

基　　金：2014年安徽省卫生计生委科研计划项目(14FR015)

摘　　要：目的对比宫腔镜联合阴式修补手术及宫腹腔镜联合修补术治疗剖宫产切口憩室的临床疗效,探索子宫切口憩室的最佳治疗方案。方法选择2012年2月—2015年9月在淮北市妇幼保健院收治的因剖宫产术后经期延长、经阴道超声诊断为子宫切口憩室的患者62例,根据手术方式不同分为阴式组(A组)和腔镜组(B组),A组共33例行宫腔镜联合阴式切口憩室修补术,B组共29例行宫腹腔镜联合修补术,2组患者的孕次、年龄差异无统计学意义(均P>0.05)。分析2组患者围手术期的手术时间、术中出血量、术后阴道流血时间及住院费用、住院时间等相关指标。结果 2组手术时间[(42.9±15.7)min vs.(60.5±12.5)min]、住院费用[(5 962.0±538.4)元vs.(12 013.4±680.2)元]、术中出血量[(24.9±16.1)ml vs.(35.1±17.8)ml]、术后阴道流血时间[(9.6±3.6)d vs.(8.0±2.2)d]差异有统计学意义(均P<0.05)。术后1年月经经期改善率(A组为93.94%,B组为93.10%)、术后2年再孕率(A组为66.67%,B组为71.43%)、术后2年复发率(A组为6.06%,B组为6.89%)和住院时间[A组(8.7±1.3)d,B组(9.1±2.3)d]2组差异均无统计学意义(均P>0.05)。结论宫腔镜联合阴式修补手术及宫腹腔镜联合修补术都是治疗剖宫产切口憩室的有效方法,宫腔镜联合阴式修补术尽管手术视野窄、对术者水平要求高,但创伤更小、手术时间更短、住院费用更低,是值得推广使用的更为有效的治疗子宫切口憩室的手术方式。Objective To compare the clinical effects of hysteroscopy combined with vaginal surgery and hysteroscopy combined with laparoscopy in the treatment of cesarean section scar diverticulums, and explore the best method for cesar- ean section scar diverticulums. Methods Total 62 cases of cesarean section scar diverticulums confirmed by transvaginal sonography, with prolonged menstrual periods after the caesarean, were treated in our hospital between February, 2012 and September, 2015. The patients were divided into two groups according to the operation. Thirty-three patients in group A received hysteroscopy combined with vaginal surgery, while 29 patients in group B received hysteroscopy combined with laparoscopy surgery. There were no significant difference in the age and pregnant times. The operative time, hospitaliza- tion cost, intraoperative blood loss and postoperative vaginal bleeding time and hospitalization time were analyzed. Re- suits In group A and B, there were significant difference in the operative time [ （42.9 ±15.7 ） min vs. （60.5 ± 12.5 ） mini, hospitalization cost [ （5 962 ±538.4）yuan vs. （ 12 013.4 ±680.2）yuan], intraoperative blood loss [ （24.9 ± 16.0） ml vs. （35.1± 17.8 ） ml ] and postoperative vaginal bleeding time [ （9.6± 3.6） days vs. 8.0 ± 2.2） days ], all P 〈 0. 05. There were no significant different between the two groups in the hospitalization time [ （ 8.7 ± 1.3 ） days vs. （9.08 ± 1.08 ） days ], amelioration of postoperative menstrual cycle （93.94% vs 93.1% ）, postoperative secondary pregnancy rate （66.67% vs. 71.43 % ） and postoperative recurrence rate （ 11.11% vs. 9.5% ）, P 〉 0. 05. Conclu- sion Both hysteroscopy combined with vaginal surgery and hysteroscopy combined with laparoscopy are suitable for Ce- sarean section scar diverticulums, however, transvaginal operation might be recommended for its short operation time, low hospitalization cost and less trauma, though the surgical field of transvaginal operation is narrow

关 键 词：剖宫产切口憩室 宫腔镜联合阴式手术 阴式手术 宫腹腔镜联合手术 

分 类 号：R713.4[医药卫生—妇产科学] R616.5[医药卫生—临床医学]