腹腔镜下Lembert缝合修复缺陷联合宫腔镜电凝治疗剖宫产瘢痕缺损的疗效观察

Therapeutic effect of laparoscopic Lembert suture repair combined with hysteroscopic electrocoagulation for treating women with previous cesarean scar defect

目的:探讨腹腔镜下Lembert缝合修复局部解剖缺陷并联合宫腔镜电凝消融局部病变内膜(简称新式宫腹腔镜联合治疗)治疗剖宫产瘢痕缺损(PCSD)的临床效果。方法:对2016年1月-2018年12月在本院诊断为PCSD并知情同意接受新式宫腹腔镜联合治疗的26例患者临床资料进行分析。结果:手术时间为(55.3±8.5)min,术中出血量(18.6±5.9)ml。所有患者术后无感染、静脉血栓形成、生殖道瘘等并发症发生。患者术后经期(6.2±2.2)d,较术前(15.7±3.3)d明显缩短(t=28.36,P<0.001),手术总有效率为96.2%。术后PCSD处残余肌层厚度(5.5±0.7)mm,较术前(1.6±0.5)mm明显增厚(t=22.10,P<0.001)。严格避孕半年,术后18个月内总妊娠率为69.2%(18/26),术后30个月内总妊娠率为80.8%(21/26),其中18例妊娠发生在术后半年后开始试孕的1年内。结论:新式宫腹腔镜联合治疗PCSD具有创伤小、不需切除原瘢痕、安全有效、术后短期即可备孕的优势,可作为病灶处残余肌层厚度<3mm并有生育要求的PCSD患者的一种新的治疗选择。

Objective:To explore the clinical efficacy of laparoscopic Lembert suture repair combined with hysteroscopic electrocoagulation for treating women with previous cesarean scar defect(PCSD).Methods:The clinical data of 26 patients with PCSD who had been given laparoscopic Lembert suture repair combined with hysteroscopic electrocoagulation based on informed consent from January 2016 to December 2018 were retrospective analyzed.Results:The average operation time and the intraoperative blood loss were 55.3±8.5 min and 18.6±5.9 ml.No patients had a complication,such as infection,venous thrombosis,or genital tract fistula.The average postoperative menstrual period of all the patients after operation was 6.2±2.2 days,which was significant shorter than that(15.7±3.3 days)of patientsbefore operation(t=28.36,P<0.001),and the total effective rate of these patients was 96.2%.The average thickness of postoperative residual muscle layer in the local of PCSD was 5.5±0.7 mm,which was significant thicker than that(1.6±0.5 mm)before operation(t=22.10,P<0.001).After strict postoperative contraception for six months,the total pregnancy rate within 18 months after operation was 69.2%(18/26),and that within 30 months was 80.8%(21/26).Among the patients with pregnancy,85.7%(18/21)of the pregnancy occurred within 1 year after operation.Conclusion:The laparoscopic Lembert suture repair combined with hysteroscopic electrocoagulation for treating women with PCSD has the advantages of less trauma,no need to remove the original scar,safety and effective.The women can ready for pregnancy in a short time after operation.So it can be used as a new treatment option for patients with PCSD(the residual muscle layer thickness less than 3mm)and fertility requirements.