腹腔镜下Lembert缝合联合宫腔镜电凝治疗剖宫产瘢痕缺损合并不孕症  

The clinical study of combining laparoscopic Lembert suture and hysteroscopic electrocoagulation for treating infertility women with previous cesarean scar defect

作　　者：贾海军[1] 杨玲 樊瑛[1] 雷萍[1] 郭海雁[1] 王晓蓉[1] JIA Haijun;YANG Ling;FAN Ying;LEI Ping;GUO Haiyan;WANG Xiaorong(Zhuhai Maternal and Child Health Care Hospital, Guangdong Province, 519000)

机构地区：[1]广东省珠海市妇幼保健院,519000

出　　处：《中国计划生育学杂志》2021年第8期1587-1591,共5页Chinese Journal of Family Planning

基　　金：珠海市科技计划医疗卫生项目(20191208E030017)。

摘　　要：目的:探讨腹腔镜下Lembert缝合联合宫腔镜电凝消融局部病变内膜治疗(简称新式宫腹腔镜联合治疗)剖宫产瘢痕缺损(PCSD)合并不孕症的临床疗效。方法:选择2016年1月-2019年1月在本院诊断为PCSD且符合纳入排除标准者56例为研究对象,其中28例实施新式宫腹腔镜联合治疗(观察组);28例实施宫腔镜联合腹腔镜下PCSD病灶切除修补术(对照组),观察比较两组手术并发症及术后恢复情况随访结果。结果:与对照组比较,观察组手术时间短,术中出血量少,术后住院时间短(P<0.05),两组患者术后无感染、静脉血栓、生殖道瘘等并发症发生。两组术后经期均较术前明显缩短,剖宫产切口处残余肌层均较术前明显增厚(P<0.05)。观察组治愈率高于对照组(85.7%比60.7%)(P<0.05),有效率(100.0%比96.4%)无差异(P>0.05)。观察组术后半年开始试孕,对照组术后1年后开始试孕,试孕1年内观察组妊娠率67.9%(19/28)高于对照组39.3%(11/28)(P<0.05)。结论:新式宫腹腔镜联合治疗PCSD较腹腔镜下PCSD病灶切除修补术缩短了术后避孕时间,适合于年龄较大,有再生育需求的PCSD患者。Objective:To explore the clinical effect of combining laparoscopic Lembert suture to repair local anatomical defects and hysteroscopic lectrocoagulation to remove the problem endometrium for treating the infertility women with previous cesarean scar defect(PCSD).Methods:56 infertility women with PCSD were selected according to the inclusion and exclusion criteria,and were randomly divided two groups according to the random number table method from July 2018 to April 2021.28 women in group A were treated with new combination therapy of hysteroscopic combined with laparoscopic for PCSD lesion resection and repair,while 28 women in group B underwent hysteroscopy combined with laparoscopic for PCSD lesion resection and repair.The surgical complications and postoperative recovery of the women were observed and compared between the two groups,and the clinical efficacy was evaluated based on the results of postoperative follow-up.Results:The operative time and postoperative hospital stay time of the women in group A were significant shorter than those of the women in group B,the intraoperative blood loss of the women was significant less(P<0.05).No postoperative complications such as infection,venous thrombosis,and genital tract fistula occurred in the two groups.Postoperative menstrual period of the women in the two groups had shortened significantly after operation,and the residual muscular layer at cesarean section incision of the women in the two groups was significant thicker than that of preoperative period(P<0.05).The cure rate(85.7%)of the women in group A was higher than that(60.7%)of the women in group B(P<0.05),but there was no significant difference in the effective rate(100.0%vs.96.4%)of the women between the two groups(P>0.05).The women in group A had tried to pregnancy trial within half one year after operation,and the women in group A had tried to pregnancy trial within one year after operation.The pregnancy rate of the women within one year of the tried pregnancy in group A was 67.9%(19/28),which was si

关 键 词：剖宫产瘢痕缺损 腹腔镜 宫腔镜 Lembert缝合法 

分 类 号：R71[医药卫生—妇产科学]