两种手术方式治疗剖宫产术后子宫瘢痕憩室所致经期延长疗效分析

Comparison of the efficacy of two surgical procedures in the treatment of CSD-induced prolonged menstrual period after cesarean section

目的探讨宫腔镜子宫瘢痕憩室下缘电切开渠术和腹腔镜下折叠对接缝合术治疗剖宫产术后子宫瘢痕憩室所致经期延长的疗效。方法回顾分析厦门大学附属中山医院2015年7月至2021年10月诊治的剖宫产术后子宫瘢痕憩室所致经期延长患者85例,其中采用宫腔镜子宫瘢痕憩室下缘电切开渠术治疗的58例为宫腔镜组,采用腹腔镜下折叠对接缝合术治疗的27例为腹腔镜组,分析两组患者的一般临床资料、围术期相关指标以及术后症状恢复状况。结果宫腔镜组和腹腔镜组的患者围术期相关指标,术中出血量、手术时间、住院费用和住院天数差异有统计学意义(P<0.05),但两组患者术后经期时间差异无统计学意义(P>0.05);宫腔镜组和腹腔镜组患者术后经期时间相较于术前明显缩短,差异有统计学意义(P<0.05)。结论宫腔镜子宫瘢痕憩室下缘电切开渠术和腹腔镜下折叠对接缝合术均能有效地改善剖宫产术后子宫瘢痕憩室所致经期延长的症状,但宫腔镜子宫瘢痕憩室下缘电切开渠术在操作简便性、手术创伤和住院费用等方面更具优势,更具临床推荐价值。

Objective To investigate the efficacy of two surgical procedures,i.e.,hysteroscopic surgery—the method of ditching by electrotomy along the lower margin of cesarean scar diverticulum(CSD),and laparoscopic surgery—the folding suture method,in the treatment of CSD-induced prolonged menstrual period after cesarean section.Methods The clinical data of 85 patients with CSD-induced prolonged menstrual period after cesarean section who underwent surgery in Zhongshan Hospital Affiliated to Xiamen University from July 2015 and October 2021 were retrospectively analyzed.Total of 85 patients,58 treated by hysteroscopic surgery were assigned to hysteroscopic group and 27 by aparoscopic surgery to laparoscopic group.The general clinical data,perioperative indicators and postoperative symptom recovery of the patients in the two groups were statistically analyzed.Results A comparison of perioperative indicators between the two groups showed that there were statistically significant differences in intraoperative blood loss,operation time,hospitalization cost and length of hospital stay(P<0.05),but there were no statistically significant differences in postoperative menstrual period(P>0.05).Compared with the preoperative period,the postoperative period of patients in both groups was significantly shortened,with statistical difference(P<0.05),Conclusions Both hysteroscopic surgery and laparoscopic surgery can effectively improve the symptoms of prolonged menstrual period in patients with CSDinduced prolonged menstrual period after cesarean section,but the former has more advantages in terms of ease of operation,surgical trauma and hospitalization costs,thus having more clinical recommendation value.