剖宫产术后子宫切口憩室的不同术式疗效观察

Clinical effect of different surgical treatment on uterine incision diverticulum after cesarean section

目的探讨剖宫产术后子宫切口憩室的不同修复术式对子宫功能的影响。方法选取2012年2月至2015年5月陆军军医大学第一附属医院妇产科收治的剖宫产术后子宫切口憩室患者141例,根据手术方式不同分为阴式手术组(70例)与腹腔镜手术组(71例)。阴式手术组为经阴道子宫切口憩室修补术治疗,腹腔镜手术组为腹腔镜下子宫切口憩室修补术治疗。观察2组患者术中情况、术后疗效和2年内再次妊娠结局,并进行对比分析。结果腹腔镜手术组患者术中出血量少于阴式手术组患者,但手术时间更长,住院费用更高,差异具有统计学意义(P <0. 05)。所有患者术后3个月随访憩室修复情况,阴式手术组治疗有效率85. 71%,腹腔镜手术组治疗有效率98. 59%,2组比较差异无统计学意义(P> 0. 05)。随访2年,腹腔镜手术组71例患者共有24例宫内妊娠,而阴式手术组70例患者中共有42例宫内妊娠,后者宫内妊娠率高于前者,差异有统计学意义(P <0. 05)。结论经阴道子宫切口憩室修补术与腹腔镜子宫切口修补术治疗剖宫产术后子宫切口憩室的临床疗效相当,两种术式各有优势,腹腔镜下子宫切口憩室修补术治疗的患者术中损伤小,而经阴道子宫切口憩室修补术治疗的患者再次妊娠结局更优。

Objective To investigate the clinical effect of different surgical treatment on uterine incision diverticulum after cesarean section. Methods A total of 141 cases with uterine incision diverticulum in first hospital affiliated to army medical university from Febuary2012 to May 2015 were divided into control group( n = 70) and observation group( n = 71) according to different surgical methods. The control group received transvaginal repair for uterine incision diverticulum,the observation group underwent laparoscopic resection of uterine scar diverticulum after repair. The intraoperative condition,postoperative curative effect and re-pregnancy outcome in 2 years were observed and compared between the two groups. Results The intraoperative blood loss of the observation group were less than that of the control group,but the operation time was longer and the cost of hospitalization was higher in observation group than those in control group,the differences were significant( P < 0. 05). All patients were followed up for 3 months,the effective rate of the control group was 85. 71%,and the effective rate of the observation group was 98. 59%,the difference was not significant( P > 0. 05). During the follow-up period of 2 years,there were 24 cases of intrauterine pregnancy in the observation group and 42 cases of intrauterine pregnancy in the control group. The intrauterine pregnancy rate of the observation group was lower,the difference was significant( P < 0. 05). Conclusion The clinical efficacy of transvaginal uterine incision diverticulum repair and laparoscopic resection of scar diverticulum after uterine repair in the treatment of uterine incision diverticulum after cesarean section are quite good,each has its advantages. Laparoscopic surgery has small trauma for patients,and transvaginal surgery is better for patients with pregnancy.