宫腔镜整复术治疗剖宫产切口憩室致异常子宫出血的疗效评价

Effectiveness of Hysteroscopic Repair of Cesarean Section Diverticulum in Patients With Abnormal Uterine Bleeding

目的探讨剖宫产切口憩室宫腔镜整复术(hysteroscopic repair of cesarean section diverticulum,HRCSD)治疗剖宫产切口憩室(cesarean section diverticulum,CSD)所致异常子宫出血的疗效。方法宫腔镜下切除憩室下缘影响经血引流的瘢痕组织,汽化憩室内子宫内膜异位灶及增生血管,对憩室进行整复。结果 CSD位置:宫颈内口水平8例,宫颈内口水平下104例。切口位于宫颈内口下0. 5～2. 5 cm,(1. 4±0. 3) cm。112例月经复潮后门诊随访3～14个月,中位随访时间6个月。治疗前月经持续(19. 2±2. 2) d (10～28 d),治疗后月经持续(7. 0±0. 8) d (2～12 d),有效率82. 1%(92/112),部分有效率11. 6%(13/112),无效率6. 3%(7/112)。19例有再次生育要求:12例术后至今未避孕未孕1～3年,4例术后避孕至今,2例术后自然受孕,足月妊娠择期行二次剖宫产术,1例行辅助生殖技术,胚胎移植2次未成功。结论 HRCSD治疗CSD所致异常子宫出血可行,疗效满意。

Objective To evaluate the effectiveness of hysteroscopic repair of cesarean section diverticulum(HRCSD)in patients with abnormal uterine bleeding(AUB)due to cesarean section diverticulum(CSD).Methods Hysteroscopic resection of scar tissue of the lower margin of diverticulum which affected menstruation drainage was made.The endometriosis and proliferation of blood vessels in the diverticulum were vaporized,and then the diverticulum was repaired.Results The CSD was located at cervical orifice in 8 cases and below the cervical orifice in 104 cases.The incision was located 0.5-2.5 cm(mean,1.4±0.3 cm)under the internal cervical orifice.After menstrual recovery,there were 112 cases followed up at clinic for 3-14 months(median,6 months).The menstruation period was(19.2±2.2)d(range,0-28 d)before the treatment and(7.0±0.8)d(range,2-12 d)after the treatment.At 6 months postoperatively,92 patients(82.1%)had improvement,13 patients(11.6%)had partial improvement,and 7 patients(6.3%)had no improvement.In 19 patients having reproductive requirements,12 patients had no pregnancy without contraception for 1-3 years,4 patients took postoperative contraception,2 patients had natural pregnancy after term pregnancy for second cesarean section,1 patient received assisted reproductive technology with 2 times of unsuccessful embryo transplantation.Conclusion HRCSD is an effective and feasible choice for patients with AUB due to CSD.