不同外科修补方案治疗剖宫产术后子宫切口憩室的疗效比较

Clinical effects comparison of different kinds of repair operation in treatment of patients with PCSD

目的探讨宫腹腔镜联合与经阴道修补术式对剖宫产术后子宫切口憩室(PCSD)患者月经时间、宫内妊娠率及复发率的影响。方法选取该院2014年1月-2016年1月收治PCSD患者共100例,根据手术方案差异分为A组(50例)和B组(50例),分别采用宫腹腔镜联合修补术式和经阴道修补术式治疗,比较两组患者手术用时、术中失血量、首次肛门排气时间、术后阴道流血时间、住院时间、月经时间恢复效果、治疗前后憩室宽度和深度、随访宫内妊娠率及复发率。结果 B组患者手术用时明显优于A组(P<0.05);A组患者术中失血量、术后阴道流血时间及住院时间均明显优于B组(P<0.05);两组患者首次肛门排气时间比较差异无统计学意义(P>0.05);两组患者月经时间恢复效果比较差异无统计学意义(P>0.05);两组患者治疗后子宫憩室宽度和深度明显短于治疗前(P<0.05);两组患者治疗后子宫憩室宽度和深度组间比较差异无统计学意义(P>0.05);两组患者随访期内宫内妊娠率和复发率比较差异无统计学意义(P>0.05)。结论两种手术修补方案治疗PCSD总体疗效接近,但宫腹腔镜联合修补术式有助于降低医源性创伤程度,减少术后阴道流血和住院时间,而经阴道修补术式则操作更为简便,手术难度显著降低。

Objective To investigate the effects of repair operation by hysteroscopy combined with laparoscopy and transvaginal on menstruation time,intrauterine pregnancy rate and recurrence rate of patients with PCSD.Methods100patients with PCSD were chosen from January2014to January2016and divided into A group(50patients)with repair operation by hysteroscopy and laparoscopy and B group(50patients)with repair operation by transvaginal;the operation time,the intraoperative blood loss,the vaginal bleeding time after operation,the anal exsufflation for first time,the hospital stay,the menstruation recovery effect,the width and depth of uterine diverticulum before and after treatment,intrauterine pregnancy rate and recurrence rate with follow-up of both groups were compared.Results The operation time of B group were significantly better than A group(P<0.05).The intraoperative blood loss,vaginal bleeding time after operation and hospital staying time of A group were significantly better than that in B group(P<0.05).There was no significant difference in the anal exsufflation for first time between the two groups(P>0.05).There was no significant difference in the menstruation recovery effect between the two groups(P>0.05).The width and depth of uterine diverticulum after treatment of both groups were significantly better than that before treatment(P<0.05).There was no significant difference in the width and depth of uterine diverticulum after treatment between the two groups(P>0.05).There was no significant difference in the intrauterine pregnancy rate and recurrence rate between the two groups(P>0.05).Conclusion Repair operation by hysteroscopy combined with laparoscopy and transvaginal in the treatment of patients with PCSD possess the same clinical effects;repair operation by hysteroscopy and laparoscopy can efficiently reduce the trauma degree in operation and shorten the vaginal bleeding time after operation and hospital staying time,and repair operation by transvaginal possess the advantage including more simply operation and lower operation difficulty.