宫腔镜憩室内膜去除联合腹腔镜瘢痕处缺损加固治疗剖宫产瘢痕憩室临床多指标回顾分析  

Retrospective analysis of hysteroscopic diverticulum endometrialablation combined with laparoscopic scar defect reinforcecement in the treatment of caesarean section scar diverticulum

作　　者：肖洁[1] 周健[1] 梁丽[1] 蔡莉[1] 方媛媛[1] 杨晓[1] 黄辉 许晨琛 董秀娟[3] XIAO Jie;ZHOU Jian;LIANG Li;CAI Li;FANG Yuanyuan;YANG Xiao;HUANG Hui;XU Chenchen;DONG Xiujuan(Department of Gynecology,Xuzhou Maternal and Child Health Care Hospital,Xuzhou,Jiangsu 221009,China;Department of Medical Record,Xuzhou Maternal and Child Health Care Hospital;Department of Ultrasound,Xuzhou Maternal and Child Health Care Hospital)

机构地区：[1]徐州市妇幼保健院妇科,江苏徐州221009 [2]徐州市妇幼保健院病案科,江苏徐州221009 [3]徐州市妇幼保健院超声科,江苏徐州221009

出　　处：《徐州医科大学学报》2020年第11期812-816,共5页Journal of Xuzhou Medical University

基　　金：第二周期江苏省妇幼健康重点人才项目(FRC:201720)。

摘　　要：目的探寻较为有效的手术治疗剖宫产瘢痕憩室的方式、方法。方法回顾性分析徐州市妇幼保健院确诊剖宫产瘢痕憩室60例患者的临床资料,均采取宫腔镜憩室内膜去除联合腹腔镜瘢痕处缺损加固的术式。术后1个月随访手术情况;术后3、6、12个月随访月经期,超声测量子宫下段瘢痕处最薄肌层的厚度及剖宫产瘢痕憩室的容积;术后24个月随访宫内妊娠例数。结果60例患者术后均无并发症;有效51例(85%),无效9例(15%),复发3例(5.0%);术后3、6、12个月月经期中位数分别为8.1、8.2、8.5 d,较术前(13.0 d)明显缩短(P<0.05);术后3、6、12个月剖宫产瘢痕憩室的容积中位数分别为0.42、0.37、0.54 cm 3,明显小于治疗前(P<0.05);术后3、6、12个月剖宫产瘢痕憩室底部到浆膜层最薄肌层厚度中位数分别为0.25、0.25、0.24 cm,大于治疗前(P<0.05)。结论宫腔镜憩室内膜去除联合腹腔镜瘢痕处缺损加固治疗剖宫产瘢痕憩室手术既可以缩短憩室患者的月经期,又可以有效修复子宫下段瘢痕处解剖结构,且不破坏憩室部位肌层组织的连续性,还可增加肌层厚度,减少再次妊娠子宫破裂的风险。Objective To explore a more effective surgical approach to treat cesarean scar diverticulum.Methods A total of 60 patients who were diagnosed with cesarean scar diverticulum in Xuzhou Maternal and Child Health Care Hospital were enrolled and their clinical data were retrospectively analyzed.All patients underwent hysteroscopic diverticulum endometrial ablation combined with laparoscopic scar defect reinforcement.The patients were followed up one month after operation,and their menstrual period was followed up 3,6 and 12 months after operation.The thickness of the thinnest muscle layer at the scar of the lower uterine segment and the volume of the cesarean scar diverticulum were measured by ultrasound.The number of intrauterine pregnancy cases was followed up 24 months after operation.Results There were no postoperative complications in all the patients;51 cases(85%)were cured,9 cases(15%)were ineffective,and 3 cases(5.0%)recurred.The median menstrual period was 8.1,8.2 and 8.5 days 3,6 and 12 months after operation respectively,which was significantly shorter than 13 days before operation(P<0.05).The median volume of the scar diverticulum of cesarean section 3,6 and 12 months after operation was 0.42,0.37 and 0.54 cm 3 respectively,which was significantly less than that before treatment(P<0.05).The median thickness from the bottom of the cesarean scar diverticulum to the thinnest muscle layer of the serosa layer 3,6 and 12 months after operation was 0.25,0.25 and 0.24 cm respectively,which was greater than that before treatment(P<0.05).Conclusions A combined use of hysteroscopic diverticulum endometrial ablation and laparoscopic scar defect reinforcement in the treatment of cesarean scar diverticulum can not only shorten the menstrual period of patients with diverticulum,but also effectively repair the anatomical structure of the lower uterine scar,without destroying the continuity of muscle tissue in the diverticulum,increasing the thickness of muscle layer and reducing the risk of uterine rupture in pregnancy a

关 键 词：剖宫产瘢痕憩室 腹腔镜 宫腔镜 瘢痕缺损加固 憩室内膜去除 

分 类 号：R719.82[医药卫生—妇产科学]