宫腔镜B超腹腔镜在剖宫产术后子宫切口憩室的临床应用价值

目的探讨宫腔镜联合B超检查诊断剖宫产术后子宫切口憩室及宫腔镜联合腹腔镜在治疗剖宫产术后子宫切口憩室的临床应用价值。方法回顾性分析2012年4月至2016年5月经宫腔镜联合B超检查诊断的154例剖宫产术后子宫切口憩室患者并进行手术治疗的临床资料，手术方式的选择通过B超和宫腔镜检查并测量子宫切口憩室的厚度决定，同时评估手术疗效、手术情况及并发症情况。结果经阴道B超单独检查诊断确定憩室患者96例（62．34％）。宫腔镜联合B超测量憩室壁厚度〈3mm的患者105例（68．18％），选择宫腔镜联合腹腔镜憩室切除修补术，有效率83．81％；憩室壁厚度≥3mm的患者49例（31．82％），选择宫腔镜憩室“开渠”术，有效率87．76％，两种手术方法有效率比较，差异无统计学意义（P〉0．05）。行宫腔镜手术的患者憩室平均厚度和宽度与手术前比较，差异无统计学意义（P〉0．05），行宫腔镜联合腹腔镜手术的患者憩室壁厚度较术前增大，宽度缩小，但差异无统计学意义（P〉0．05）。结论宫腔镜联合B超检查是诊断剖宫产术后子宫切口憩室的理想方法，根据憩室的厚度选择手术方式可有效减少手术创伤，提高患者治愈率。

Objective To study the clinical application value of diagnosis of post-cesarean section scar diverticulum （ PCSD ） -by hysteroscopy combined with ultrasonography and treatment with hysteroscopy combined with laparoscopy. Methods From April 2012 to May 2016, 154 patients with PCSD were diagnosed by hysteroscopy combined with ultrasonography in our hospital.The clinical data were retrospectively analyzed.The choice of operation method was decided by B-ultrasonography and hysteroscopy, and the thickness of the uterine incision diverticulum was measured.The curative effect, operation and complications were also evaluated. Results 96 cases of diverticulum were diagnosed by transvaginal ultrasonography alone, accounted for 62.34% （ 97/154 ） .Thickness of less than 3 mm in 105 cases were treated by hysteroscopic diverticulum repair surgery accounted for 68.18% （ 105/154 ） , and the operative rate was 83.81% （ 49/104 ） .More than 3mm in 49 cases （ 49/154 ） were treated with hysteroscopy diverticulum incision, the effective rate was 87.76% （ 43/49 ） .There was no significant difference in the effective rate of surgical methods （ P〉0.05 ） .The mean thickness and width of diverticulum in patients underwent hysteroscopy were not statistically different from those before operation （ P〉0.05 ） , the thickness of diverticulum in patients underwent hysteroscopy combined with laparoscopic surgery were larger than that before operation, but the difference was not statistically significant （ P〉0.05 ） . Conclusion Hysteroscopy combined with type-B ultrasonic is an ideal method for the diagnosis of uterine incision diverticulum after cesarean section.Choosing the surgical method according to the thickness of the diverticulum can effectively reduce the trauma and improve the cure rate.