阴式及腹腔镜途径修补剖宫产瘢痕憩室预后的队列研究

Prognosis of Transvaginal or Laparoscopic Repair of Cesarean Scar Defect: A Retrospective Cohort Study

目的:探讨经阴道途径与腹腔镜途径修补剖宫产瘢痕憩室的治疗效果及预后情况。方法:回顾性分析北京协和医院接受阴式或腹腔镜剖宫产瘢痕憩室修补的67例剖宫产瘢痕憩室患者临床资料,其中阴式组31例,腹腔镜组36例。比较两组术中术后情况,并随访术后再妊娠结局。结果:阴式组与腹腔镜组相比,手术时间明显缩短(48.06±16.40分钟vs 80.28±29.32分钟,P<0.01),两组术后最高体温、术后留置尿管时间、术后住院时间、术后瘢痕剩余肌层厚度(TRM)及术后经期进行比较,差异无统计学意义(P>0.05)。阴式组手术费平均568.1元,腹腔镜组手术费平均2639.6元。两组患者的TRM在术后都有明显的增厚(阴式组增厚:2.70±2.13 mm,腹腔镜组增厚:2.87±2.09 mm),差异无统计学意义(P>0.05);阴式组96.3%的患者和腹腔镜组83.9%的患者经期都缩短至10天以内,两组比较差异无统计学意义(P>0.05)。两组累积妊娠率(34.8%vs 50.0%)比较,差异无统计学意义(P>0.05)。结论:阴式修补术与腹腔镜修补术治疗效果和术后再妊娠结局相似,但阴式修补术更经济。

Objective： To evaluate whether the prognosis of transvaginal repair of cesarean scar defect was similar with the standard laparoscopic approach in the field of bleeding correction,increased myometrial thickness and better obstetric outcomes.Methods： This cohort study included 67 symptomatic women with cesarean scar defects and menstrual symptoms in Peking Union Medical College Hospital.There were 31 cases in the vaginal group and36 cases in the laparoscopic group.The intraoperative and postoperative conditions were compared between the two groups,and follow-up re-pregnancy outcomes were followed.Results： Compared with the laparoscopic group,the operative time was significantly shorter than that in the vaginal group（ 48. 06 ± 16. 40 min vs 80. 28 ± 29. 32 min,P〈0. 01）.There was no significant difference in the highest postoperative temperature,postoperative catheter length,postoperative hospital stay time,postoperative thickness of the remaining myometrium（ TRM） and postoperative menstrual period between the two groups（ P〉0. 05）.In the vaginal group,the average operating cost was568. 1 yuan,and the laparoscopic group had an average of 2639. 6 yuan. TRM in both groups was significantly thickened after surgery（ vaginal thickening： 2. 70 ± 2. 13 mm vs.laparoscopic thickening： 2. 87 ± 2. 09 mm）,and the difference was not statistically significant（ P〉0. 05）. The menses duration of 30 patients from each group（ 96. 3% transvaginal vs.83. 9% laparoscopic） was within 10 days,there was no significant difference between the two groups（ P〉0. 05）.Comparison of cumulative pregnancy rates,there was no significant difference between the two groups（ P〉0. 05）.Conclusions： The effect of vaginal repair and laparoscopic repair is similar to that of postoperative re-pregnancy outcomes,but vaginal repair is more economical.