剖宫产后切口憩室发病人群特点及不同方式治疗效果的回顾性调查

Retrospective investigation of features of people with incision diverticulum after cesarean section and effects of different treatment regimens

目的 研究剖宫产后切口憩室发病人群特点及不同方式的治疗效果.方法 选择2013年1月至2015年3月因保守治疗失败行手术治疗的剖宫产术后子宫切口憩室患者75例为观察组,另选取60例同期入院行剖宫产术但未发生切口憩室的产妇为对照组,分析剖宫产后切口憩室发病人群特点,并按照手术方式将其分为宫腹腔镜组、宫腔镜组、阴式组,每组25例,分析不同手术方式的治疗效果,比较围术期指标与并发症.结果 观察组手术切口临近宫颈内口、产后感染、妊娠期高血压、妊娠期糖尿病史、孕次达5次以上比例高于对照组（P〈0.05）;宫腹腔镜及阴式手术治疗有效率（96.0%、92.0%）明显高于宫腔镜（68.0%,P〈0.05）,宫腹腔镜与阴式手术治疗效果比较差异未见统计学意义（P〉0.05）;三组手术时间、住院时间、术中出血量比较差异未见统计学意义（P〉0.05）;三组术后并发症发生率（8.0%、2.0%、12.0%）比较差异未见统计学意义 （P〉0.05）.结论 剖宫产患者产后易受手术切口位置、产后感染、妊娠期高血压及糖尿病等影响而发生切口憩室,宫腹腔镜、宫腔镜、阴式手术中宫腹腔镜手术治疗效果最高,但术后均有一定并发症,临床应根据情况采取合适的治疗方式.

Objective To investigate the features of patients with incision diverticulum after cesarean section and effects of different treatment regimens.Methods Seventy-five patients with incision diverticulum after cesarean section who underwent surgical treatment because of failed conservative treatment from January 2013 to March 2015 were enrolled in the observation group.Another 60 pregnant women hospitalized for cesarean section and without incision diverticulum were selected as control group.Features of people with incision diverticulum after cesarean section were analyzed.According to the operation method, they were divided into hysteroscopy-laparoscopy group, hysteroscopy group and the vaginal type group, with 25 cases in each group.The therapeutic effects of different surgical treatments were analyzed.Perioperative indexes and complications were compared.Results The incidences of patients with incision near internal opening of cervix, postpartum infection, gestational hypertension, gestational diabetes, gravidity more than five times were higher than those of the control group （P〈0.05）.The effective rates of hysteroscopic combined with laparoscopic surgery and transvaginal surgery （96.0%, 92.0%） were significantly higher than that of hysteroscopy （68.0%,P〈0.05）.There was no significant difference in the therapeutic effect between laparoscopy combined with laparoscopic surgery and transvaginal surgery （P〉0.05）.There were no significant differences among the three groups in operation time, length of hospital stay or intraoperative blood loss （P〉0.05）.There was no significant difference in the incidence of postoperative complications（8.0%, 2.0%, 12.0%） among the three groups （P〉0.05）.Conclusions Patients with cesarean section are easy to have incision diverticulum, induced by location of incision, postpartum infection, gestational hypertension and diabetes.Among hysteroscopic combined with laparoscopic surgery, hysteroscopic surgery and transvaginal surgery, the effect of hysteroscopic combined with laparoscopic surgery is the best.However, after surgery, there are some complications.In clinics, appropriate treatment should be taken according to the realtime situation.