宫腹腔镜联合修补术对剖宫产后子宫切口瘢痕憩室的临床治疗效果

Clinical effect of hysteroscopy combined with laparoscopy in treatment of uterine incision scar diverticulum after cesarean section

目的探讨宫腹腔镜联合修补术对剖宫产后子宫切口瘢痕憩室的临床治疗效果,为制定合理的临床治疗方案提供依据。方法选取2015年3月-2017年3月在温岭市妇幼保健院接受治疗的122例诊断为剖宫产术后子宫瘢痕憩室患者随机分为观察组和对照组各61例,观察组患者治疗采用宫腹腔镜联合修补术,对照组患者采用阴道手术治疗。对两组患者住院时间、术中出血量、手术时间进行比较,对比两组患者术后肛门排气时间、阴道出血时间及最高体温并进行统计分析;对患者进行3个月随访,观察患者憩室修复和并发症情况,比较两组患者手术前后各项血清指标情况。结果观察组患者住院时间、术中出血量明显少于对照组患者,手术时间明显多于对照组患者,差异均有统计学意义(均P<0.05)。两组患者肛门排气时间、阴道出血时间观察组较对照组均明显缩短,差异有统计学意义(P<0.05);术后两组患者最高体温相比较差异无统计学意义(P>0.05)。两组患者手术治疗效果、并发症发生率差异无统计学意义(P>0.05)。手术前两组患者各血清指标水平比较差异无统计学意义(P>0.05);手术治疗7 d后所检测各项血清指标水平观察组明显低于对照组,差异有统计学意义(P<0.05)。结论宫腹腔镜联合修补术对剖宫产后子宫切口瘢痕憩室临床疗效显著,术后恢复快,且手术中出血量少,住院周期短,更适合在当前专科医院、综合医院推广。

Objective To explore the clinical effect of hysteroscopy combined with laparoscopy in treatment of uterine incision scar diverticulum after cesarean section,provide a basis for making reasonable clinical treatment plan. Methods From March 2015 to March2017,122 patients diagnosed as uterine incision scar diverticulum after cesarean section and treated in Wenling Municipal Maternal and Child Health Care Hospital were selected and randomly divided into observation group and control group,61 patients in each group. The patients in observation group were treated with hysteroscopy combined with laparoscopy,and the patients in control group were treated with vaginal surgery. The hospitalization time,the amounts of blood loss during operation,operation time,anal exhausting time after operation,vaginal bleeding time,and the highest body temperature in the two groups were compared statistically. The patients were followed up for 3 months to observe diverticulum repair and complications. The serum indexes before and after operation in the two groups were compared.Results The hospitalization time and the amount of blood loss during operation in observation group were statistically significantly less than those in control group,operation time in observation group was statistically significantly higher than that in control group(P<0. 05). Anal exhausting time after operation and vaginal bleeding time in observation group were statistically significantly shorter than those in control group(P<0. 05). There was no statistically significant difference in the highest body temperature after operation between the two groups(P>0. 05). There was no statistically significant difference in curative effect and incidence rate of complications between the two groups(P>0. 05). There was no statistically significant difference in the levels of serum indexes before operation between the two groups(P>0. 05).The levels of serum indexes at 7 days after operation in observation group were statistically significantly lower than those in control group(P<0. 05). Conclusion The clinical effect of hysteroscopy combined with laparoscopy in treatment of uterine incision scar diverticulum after cesarean section is significant,the therapy has the advantages of rapid recovery,a little bleeding during surgery,and short hospital stay,which is suitable for special hospitals and general hospitals.