腹腔镜联合宫腔镜修补术与阴式修补术治疗子宫剖宫产切口憩室对比研究

Comparative Study of Laparoscopic Hysteroscopy and Vaginal Repair in the Treatment of Uterine Cesarean Section Incision Diverticulum

目的对比研究腹腔镜联合宫腔镜修补术与阴式修补术治疗子宫剖宫产切口憩室的临床效果。方法随机选取该院自2015年1月—2016年12月收治的子宫剖宫产切口憩室患者70例作为临床研究对象,将其分成腔镜组和阴式组各35例,对腔镜组患者采用腹腔镜联合宫腔镜修补术治疗,对阴式组患者采用阴式修补术治疗,观察比较两组患者的手术情况、憩室深度、憩室宽度及经期改善情况、预后情况。结果手术时长相比腔镜组(75.4±15.4)min显著长于阴式组(61.2±10.6)min(P<0.05);术中出血量相比腔镜组(80.6±16.1)mL显著少于阴式组(122.5±12.7)mL(P<0.05);术后阴道出血时间相比腔镜组(7.2±1.9)d显著短于阴式组(9.8±2.7)d(P<0.05);腔镜组的术后胃肠功能恢复时间(3.5±2.2)h和阴式组(3.6±2.5)h相比差异无统计学意义(P>0.05);住院时间相比腔镜组(5.4±2.2)d显著短于阴式组(8.7±1.9)d(P<0.05)。手术前腔镜组的憩室深度、憩室宽度及经期分别为(10.6±3.2)mm、(21.1±4.6)mm、(14.3±4.8)d,阴式组分别为(10.4±3.0)mm、(20.9±4.7)mm、(14.6±4.4)d,差异无统计学意义(P>0.05);手术后腔镜组分别为(4.3±1.6)mm、(11.5±3.8)mm、(7.0±3.6)d,阴式组分别为(4.5±1.9)mm、(11.8±3.4)mm、(7.2±3.2)d,较手术前均有显著改善(P<0.05),两组相比差异无统计学意义(P>0.05)。腔镜组的治疗有效率、复发率和再妊娠率分别为97.1%、2.9%、22.9%,阴式组分别为94.3%、5.7%、20.0%,差异无统计学意义(P>0.05)。结论在子宫剖宫产切口憩室的治疗中,腹腔镜联合宫腔镜修补术与阴式修补术各有优势,都是十分有效的手术方法,在实际治疗中应根据具体情况选择适合的方案。

Objective To compare the clinical effect of laparoscopic hysteroscopy and vaginal repair in the treatment of uterine cesarean section incisional diverticula.Methods A total of 70 patients with uterine cesarean section incisional diverticulum were random selected from January 2015 to December 2016.The patients were divided into laparoscopic group and35 cases of vaginal group.Laparoscopic group Hysteroscopy treatment, the vaginal group of patients with vaginal repair treatment, compared the two groups of patients with the operation, diverticulum depth, diverticulum width and menstrual improvement, prognosis.Results The duration of the operation was significantly longer than that of the lumen group(75.4±15.4)min, which was significantly longer than the shade group(61.2±10.6)min(P<0.05);The amount of blood in the technique was significantly less than that of the lumen group(80.6±16.1)mL, which was significantly less than the negative group(122.5±12.7)mL(P <0.05);The time of postoperative vaginal bleeding was significantly shorter than the lumen group(7.2±1.9)d and(9.8±2.7)d(P<0.05).The functional recovery time(3.5±2.2)h of the endoscopic group was statistically significant(P>0.05) compared with the h and the negative group(3.6±2.5)h.The hospitalization time was significantly shorter than the lumen group(5.4±2.2)d and(8.7±1.9)d(P<0.05).Before the operation cavity mirror group diverticulum depth and width of the diverticulum and menstrual period(10.6 ±3.2)mm、(21.1 ±4.6)mm、(14.3 ±4.8)d, Yin type group(10.4±3.0)mm、(20.9±4.7)mm、(14.6±4.4)d,there was no statistically significant difference(P>0.05);Cavity mirror after surgery group respectively(4.3±1.6)mm、(11.5±3.8)mm、(7.0±3.6)d, Yin type group, respectively(4.5±1.9)mm、(11.8±3.4)mm、(7.2±3.2)d, compared with before operation were improved significantly(P<0.05), there was no statistically significant differences in the two groups(P >0.05).Cavity mirror group treatment effectiveness, the recurrence rate and pregnancy rate of97.1%, 2.9% and 22.9% respectively, Yin group are 94.3%, 5.7% and 94.3% respectively, there was no statistically significant difference(P>0.05).Conclusion In the treatment of uterine cesarean incision diverticulum, laparoscopic combined with hysteroscopy and vaginal repair have their own advantages, should be based on specific circumstances to choose the appropriate program.