妇科微创手术在剖宫产子宫切口瘢痕憩室治疗中的疗效分析

Comparative analysis of the efficacy of minimally invasive gynecologic surgery in treating patients with previous cesarean scar defect

目的:分析比较单纯宫腔镜电切术、宫腹腔镜联合手术及阴式憩室修补术治疗剖宫产子宫切口瘢痕憩室的临床疗效。方法:选择2013年3月至2016年7月40例剖宫产子宫切口瘢痕憩室患者,其中12例行宫腔镜下电切术(A组),15例行宫腹腔镜联合手术(B组),13例行阴式憩室修补术(C组)。比较三组手术时间、出血量、术后住院时间、住院费用及治愈率。结果:A组在手术时间、出血量、术后住院时间、住院费用方面少于其他两组,治愈率低于其他两组,差异有统计学意义(P<0.05)。B组手术时间、住院费用多于C组,差异有统计学意义(P<0.05)。B、C两组在出血量、术后住院时间、治愈率方面差异无统计学意义(P>0.05)。结论:三种微创手术各有优势,宫腔镜电切术住院时间短,住院费用低,治愈率也较低;宫腹腔镜联合手术时间较长、住院费用高,但疗效确切;阴式手术住院费用较低,疗效确切;应根据患者的实际情况选择合适的手术方式。

Objective：This study aims to compare and analyze the clinical effects of treating previous cesarean scar defect by hysteroscopy,hysteroscopy combined with laparoscopy or vaginal operation.Methods：A total of 40 patients who suffered from previous cesarean scar defect were enrolled into the study from Mar.2013 to Jul.2016.12 cases were performed hysteroscopic operation（group A）,15 cases were performed hysteroscopy combined with laparoscopic surgery（group B）,while other 13 cases were performed vaginal surgery（group C）.The operation time,intraoperative blood loss,postoperative hospital stay,hospitalization expenses and the cure rate of three groups were compared.Results：The operative time,intraoperative blood loss,postoperative hospital stay,hospitalization expenses and the cure rate of group A were significantly lower than the other two groups,the differences were statistically significant（P〈0.05）.The operative time and hospitalization expenses of group B were significantly higher than group C,and the difference was statistically significant（P〈0.05）.No significant differences were discovered in intraoperative blood loss,postoperative hospital stay and the cure rate between group B and group C（P〉0.05）.Conclusions：Each of the three types of minimally invasive surgery has its advantages,hysteroscopic surgery has fewer days of hospital stay and hospitalization expenses,yet the cure rate is low.Hysteroscopy combined with laparoscopic operation has longer operative time and higher hospitalization expenses,but it is very effective.The hospitalization expenses of vaginal operation are low,and this procedure is also very effective.Surgeons should choose appropriate surgical approach according to the actual situation of patients.