改良式宫腔镜治疗子宫瘢痕憩室的疗效及生殖预后

The Curative Effect and Reproductive Prognosis of Modified Hysteroscope in the Treatment of Cesarean Scar Diverticulum

目的探讨有效治疗子宫瘢痕憩室及复原子宫生殖功能的方法。方法收集2017年1月—2019年1月收治的子宫瘢痕憩室患者80例,其中改良组52例,在传统术式的基础之上构建“引流沟”;余28例为对照组,采用传统术式。结果术前改良组和对照组宫颈黏液肿瘤坏死因子-α(TNF-α)、白细胞介素-2(IL-2)和pH值差别均无统计学意义(P>0.05);术后改良组TNF-α[10.8(4.6~17.0)]ng/L和IL-2[198.8(102.6~295.0)]ng/L均显著低于对照组[14.9(8.3~21.5)、279.9(173.3~386.5)ng/L](P<0.05),而pH值[7.5(6.1~8.9)]显著高于对照组[6.3(4.7~7.9)](P<0.05)。术后改良组经期(5.7±1.4)d显著短于对照组(7.3±1.2)d(P<0.05),经期缩短时间(4.4±0.4)d显著多于对照组(3.1±0.2)d(P<0.05)。两组患者的自然流产率、早产率和足月产率差别均无统计学意义(P>0.05);改良组妊娠率(71.2%)显著高于对照组(39.3%)(P<0.05)。两组患者的并发症发生率差别无统计学意义(P>0.05)。宫颈黏液的TNF-α、IL-2水平与妊娠率呈负相关(P<0.05),而pH值与妊娠率呈正相关(P>0.05)。结论在传统术式基础之上构建“引流沟”可显著提高子宫瘢痕憩室的治疗效果,改善宫颈的理化环境,从而有效复原子宫的生殖功能。

Objective To explore the more effective method to treat cesarean scar diverticulum and restore reproductive function of uterine.Methods From January 2017 to January 2019,80 case of patients with cesarean scar diverticulum were retrospectively analyzed.52 case in improvement group were given the traditional operation added to build a“drainage ditch”,while 28 cases in control group were only given the traditional operation.Results The TNF-αlevel,IL-2 level and pH value was no significant difference between the improvement group and the control group before operation(P>0.05).But between the improvement group and the control group,the TNF-αlevel was[10.8(4.6-17.0)]ng/L vs[14.9(8.3-21.5)]ng/L(P<0.05),the IL-2 level was[198.8(102.6-295.0)]ng/L vs[279.9(173.3-386.5)]ng/L(P<0.05),and the pH value was[7.5(6.1-8.9)]vs[6.3(4.7-7.9)](P<0.05).While the postoperative menstrual period was(5.7±1.4)d vs(7.3±1.2)d(P<0.05),between the improvement group and the control group,the reduced time of postoperative menstrual period was(4.4±0.4)d vs(3.1±0.2)d(P<0.05).Spontaneous abortion rate,premature delivery rate and term delivery rate was no significant difference between the improvement group and the control group(P>0.05),but pregnancy rate was 71.2%vs 39.3%(P<0.05).Complication rate was no significant difference between the improvement group and the control group(P>0.05).The TNF-αand IL-2 level of cervical mucus was negatively correlated with the pregnancy rate of patient(P<0.05),but the pH value of cervical mucus was positively correlated with the pregnancy rate of patient(P<0.05).ConclusionThe traditional operation added to build a“drainage ditch”which can significantly improve the therapeutic effect of cesarean scar diverticulum and ameliorate the physical and chemical environment of cervix,may effectively restore the reproductive function of uterine.