3种剖宫产切口疤痕憩室修补术疗效比较分析

Three different approaches of surgical repair for Cesarean scar diverticulum

目的:评价3种路径的剖宫产切口疤痕憩室修补术的主、客观疗效及安全性.方法:选取诊断明确、有生育要求或疤痕憩室顶端肌层厚度<2 mm、有症状的剖宫产切口疤痕憩室(CSD)患者26例,行疤痕憩室修补术,根据术后月经期有无缩短及症状是否消失评价其主观疗效,根据术后超声检查憩室是否消失评价其客观疗效.结果:26例患者其中6例行腹腔镜修补术,8例开腹修补术,12例经阴道修补术,随访(12.6±6.3)月,其中治愈12例,好转6例,无效8例(均为经阴道手术);主观有效率为69.2%(18/26);术后月经期(9.5±4.0)d较术前(12.6±4.1)d明显缩短(P<0.001).术后复查阴道B超,16例憩室消失,客观治愈率为61.5%,无手术并发症.结论:疤痕憩室修补术是治疗CSD的有效、安全的术式,适合有生育要求且憩室顶端肌层较薄的患者.

Aim: To evaluate the efficacy and safety of three different surgical techniques for repair of Ceserean scar diverticulum( CSD). Methods: 26 symptomatic women with CSDs who desired to conceive or to maintain a myometrial thickness of < 2 mm,under transvaginal ultrasound( TVU),were treated with surgical revision. The subjective and objective effects of the therapies and the complications were evaluated. Results: Multiple techniques were performed for repair of CSD in the 26 patients,including 6cases of laparoscopic,8 of laparotomic and 12 of vaginal revision. After a follow- up of( 12. 6 ± 6. 3)months,we found 12 patients with recovery,6 with improvements and 8 of failure. All of the 8 failed patients were treated through vaginal procedure. The rate of subjective success was found to be 69. 2%( 18 /26). Postoperative duration of menstruation was found to be significantly longer than pre- operative duration of menstruation( 12. 6 ± 4. 1 vs 9. 5 ± 4. 0,P < 0. 001). All patients were examed with TVU in3 months after surgery,and the defects were no longer detectable in 16 women,giving an objective success rate of 61. 5%; however,in the other 10 patients TVU showed persistence of CSD,of which 6 had continuous symptoms. There were no complications observed in the present study. Conclusion: Different techniques used in surgical repair for CSD are effective and safe,especially suitable for symptomatic pa-tients who wish to conceive or want to maintain the myometrial thickness of < 2 mm on TVU. It's recommended to choose different techniques based on the surgeon's proficiency.