剖宫产子宫瘢痕憩室52例的临床诊治分析

Clinically diagnostic and therapeutic analysis of 52 patients with cesarean scar

目的探讨宫腔超声造影对于剖宫产子宫瘢痕憩室的诊断意义及不同微创手术方法的临床效果。方法选择本院2012年3月至2015年10月因剖宫产子宫瘢痕憩室住院行手术治疗患者共52例,术前行经阴道超声及宫腔超声造影检查,并测量憩室相关指标,全部患者分为A和B两组,A组32例行宫腔镜剖宫产子宫瘢痕憩室修补术,B组20例行宫腔镜探查术+腹腔镜剖宫产子宫瘢痕憩室切除术+子宫修补术,比较两组的手术时间、出血量、术后住院天数,以及两种手术方案治疗效果。结果宫腔超声造影检查诊断剖宫产子宫瘢痕憩室准确率100%,经阴道超声检查准确率80.8%。阴道不规则流血持续时间>5d时,测量憩室长度为(9.3±0.5)mm,症状≤5d时,其长度为(7.6±0.6)mm,两组的憩室长度有显著的差异(P<0.05﹚;后位子宫,测量憩室深度为(7.5±0.4)mm,前位子宫,其深度为(5.9±0.4)mm,两者比较差异有统计学意义(P<0.05﹚;A组在手术时间、出血量及术后住院天数均少于B组,两组比较具有统计学意义(P<0.05﹚;两组术式均无手术并发症发生;A组手术有效率90.6%,B组有效率95%,差异无统计学意义(P>0.05)。结论宫腔超声造影在诊断剖宫产子宫瘢痕憩室时准确度更高,可以作为临床重要的辅助检查手段;剖宫产子宫瘢痕憩室的长度可能与症状的轻重有关,后位子宫较前位子宫更易发生剖宫产子宫瘢痕憩室;宫腔镜及宫腹腔镜联合手术在治疗剖宫产子宫瘢痕憩室时均取得了良好的临床效果,对于无生育要求的患者,宫腔镜手术是一种操作简便、恢复快且创伤小的治疗方案,对于有生育要求的患者,可选择宫腹腔镜联合手术,可以更好地修复憩室。

Objective： To explore the diagnostic significance of sonohysterography for the patients with previous cesarean scar defect（PCSD）and clinical effect of treatment by different minimally invasive surgery. Methods： A total of 52 patients who were treated surgically because of previous cesarean scar defect in Shengjing Hospital from March 2012 to October 2015. All the patients had transvaginal ultrasound and sonohysterography examination, and their related indicators of diverticula were measured. The patients were divided two groups：The patients underwent hysteroscopic PCSD repair surgery in group A （n=32） ; and the patients underwent combined of hysteroscopic and laparoscopic PCSD resection and uterine repair surgery in group B （n = 20）. The operation time, bleeding volume, postoperative hospital stay, and the clinical effect of different surgical method were compared between the two groups. Results： The diagnostic accuracy rate for PCSD is 100% by sonohysterography,while that is 80.8% by tansvaginal ultrasound. The length of PCSD was （9.3±0.5） mm when the irregular vaginal bleeding duration was more than 5 days,while the length was （7.6±0.6） mm when the bleeding duration was 45 days. The bleeding duration was significantly different between the two groups （P〈0.05） . The depth of posterior uterus [（7.5±0.4） vs. （5.9±0.4） mm]was significantly different with that of anterior uterus （P〈0.05 ） The operation time, bleeding volume and postoperative hospital stay in group A were significantly less than those of group B （P〈0.05） There was no surgical complications occurred in the two groups. The effective rate of group A （90.6G） was not significantly different with that of group B （95G） （P〉0.05）. Conclusions： The sonohysterography has higher diagnostic accuracy for previous cesarean scar defect, which can be used as an important clinical auxiliary examination method. The length of PCSD may associate with the severity of symptoms. PCSD is more likely to happen in posterior uterus compared to anterior uterus. Hysteroscopy surgery or combined of hysteroscopy and laparoscopy surgery can achieved good clinically therapeutic effect. The hysteroscopy surgery is a kind of method with simpleness, quick recovery and small trauma, which is suitable for the patients without fertility requirement. The best choice is the combined of hysteroscopy and laparoscopy surgery, which can better repair previous cesarean scar defect,for patients with fertility requirements.