剖宫产子宫瘢痕憩室两种自然腔道手术的疗效比较

Comparison of two surgical approaches to uterine scar diverticulum through natural orifices

目的探讨经宫腔镜子宫瘢痕憩室刨削术及经阴道子宫瘢痕憩室切除缝合术治疗子宫瘢痕憩室的疗效及临床应用价值。方法选择2016-06至2019-06解放军总医院海南分院收治的剖宫产术后经期延长的患者共84例,均经B超联合宫腔镜检查确诊为子宫瘢痕憩室,其中31例采用宫腔镜瘢痕憩室刨削术治疗(宫腔镜组),53例采用经阴道子宫瘢痕憩室切除缝合术治疗(经阴道手术组)。结果两种手术术后3个月的总有效率分别为宫腔镜组87.1%、经阴道手术组86.8%;宫腔镜组及经阴道手术组平均手术时间分别为(19.3±6.1)min及(33.3±7.1)min;宫腔镜组及经阴道手术组平均术中出血量分别为(11.5±3.7)ml及(48.2±10.7)ml;宫腔镜及经阴道组术后疼痛评分分别为(1.3±0.9)分及(3.3±1.1)分;住院费用分别为(4817±386)元及(11071±1041)元,术后住院天数分别为(1.4±0.7)d及(3.2±0.8)d。两种手术方式疗效差异无统计学意义,但手术时间、手术中出血量、术后疼痛程度、术后住院时间及费用方面宫腔镜手术具有明显优势。结论两种经自然腔隙治疗子宫瘢痕憩室的手术方式均能取得较满意的临床治疗效果,其中宫腔镜手术较经阴道手术出血少、手术及住院时间短,治疗费用低,适合临床上开展应用于子宫瘢痕憩室的治疗。

Objective Objective To explore the efficacy and clinical applicability of two surgical approaches to uterine scar diverticulum(hysteroscopy and transvaginal uterine scar diverticulum resection)through natural orifices.Methods A total of 84 patients with prolonged menstrual periods after cesarean section admitted between June 2016 and June 2019 were confirmed to be cases of uterine scar diverticulum by B ultrasound and hysteroscopy examination.Thirty-one of them were treated with hysteroscopic resection,and the rest with transvaginal uterine scar diverticulum resection.Resluts The total effective rate was 87.1%in the hysteroscopy group and 86.8%in the transvaginal surgery group three months after operation.The average duration of surgery in the hysteroscopy group and transvaginal surgery group was(19.3±6.1)min and(33.3±7.1)min,respectively.The mean volume of intraoperative blood loss was(11.5±3.7)ml in the hysteroscopy group and(48.2±10.7)ml in the transvaginal surgery group,respectively.The postoperative pain scores of the hysteroscopy group and transvaginal group were(1.3±0.9)and(3.3±1.1)respectively.Hospitalization expenses were(4817±386)and(11071±1041)yuan,and postoperative hospital stay was(1.4±0.7)days and(3.2±0.8)days,respectively.There was no significant difference in the therapeutic effect between the two approaches.Conclusions The two surgical approaches to uterine scar diverticulum through natural orifices can both achieve satisfactory clinical outcomes,but hysteroscopic resection involves less bleeding,shorter duration of surgery and hospital stay,and lower expenses than transvaginal surgery,so it is suitable for extensive clinical application in the treatment of uterine scar diverticulum.