两种不同手术方式治疗剖宫产切口憩室的疗效分析

Clinical efficacy of two different surgical methods in treatment of previous cesarean scar defect

目的探讨宫腔镜剖宫产切口憩室修整术和宫腔镜检查联合经阴道剖宫产切口憩室修补术两种手术方式治疗剖宫产切口憩室(PCSD)的临床疗效,寻找最佳手术方式,指导临床治疗。方法回顾性分析2017年1月至2022年2月首都医科大学附属复兴医院收治的70例PCSD患者的临床资料,根据手术方式分为2组,A组为宫腔镜检查联合经阴道行剖宫产切口憩室修补术,共33例;B组为宫腔镜剖宫产切口憩室修整术,共37例。比较2组患者手术时间、术中出血量、术后阴道出血时间、住院时间、总费用、术后月经改善情况、剖宫产切口憩室恢复情况及妊娠率。结果A组与B组手术时间[(95.91±4.54)minvs(80.0±10.20)min,P<0.01min]、术中出血量[(40.91±2.66)mLvs(5.14±0.01)mL,P<0.01]、术后阴道出血时间[(7.56±1.64)dvs(9.47±1.83)d,P<0.05]、住院天数[(5.45±0.23)dvs(2.86±0.29)d,P<0.01]、总费用[(1.07±0.23)万元vs(0.68±0.12)万元,P<0.01]、术前残余肌层厚度[(2.35±0.179)mmvs(3.31±0.33)mm,P<0.01]、术后残余肌层厚度[(6.02±0.13)mmvs(2.83±0.46)mm,P<0.01]相比较差异均有统计学意义,A组与B组妊娠率差异无统计学意义(50%vs45%,P>0.05)。结论两种手术方式临床上各有优势,因此应根据患者具体情况及要求,选择最佳手术方式。

Objective To compare the clinical efficacy between hysteroscopy-assisted transvaginal repair of scar defect and hysteroscopic cesarean scar defect repair in the treatment of patients with previous cesarean scar defect.Methods Clinical data of 70 patients with previous cesarean scar defect who received surgical treatments in the Fuxing Hospital affiliated to Capital Medical University from January 2017 to February 2022 were collected and they were divided into two groups according to the operation mode.Group A consisted of 33 patients who underwent hysteroscopy-assisted transvaginal repair of scar defect.In group B,37 cases were treated with hysteroscopic cesarean scar defectrepair.The surgical conditions,surgical efficacy and following-up the pregnant outcome were analyzed.Results The operation time[(95.91±4.54)min vs(80.0±10.20)min,P<0.01)min],intraoperative bleeding volume[(40.91±2.66)mL vs(5.14±0.01)mL,P<0.01],postoperative vaginal bleeding time[(7.56±1.64)d vs(9.47±1.83)d,P<0.05],hospitalization days[(5.45±0.23)d vs(2.86±0.29)d,P<0.01],total cost[(1.07±0.23)million vs(0.68±0.12)million,P<0.01],preoperative residual muscle thickness[(2.35±0.179)mm vs(3.31±0.33)mm,P<0.01]in group A and group B were significantly different.The thickness of residual muscle layer after operation[(6.02±0.13)mm vs(2.83±0.46)mm,P<0.01]was significantly different(P<0.05),but the difference in pregnancy rate between group A and group B was not statistically significant(50%vs 45%,P>0.05).Conclusion The two surgical methods have their own clinical advantages,so the best surgical method should be selected according to the specific conditions and requirements of patients.