剖宫产术后子宫瘢痕憩室的治疗方式及疗效

Treatment mode and efficacy of uterine scar diverticulum after cesarean section

目的:分析有异常阴道流血症状的子宫瘢痕憩室(CSD)患者采用四种不同方式治疗的效果,探讨该类患者适宜的治疗方式。方法:回顾性分析2016年至2021年收治的208例有异常阴道流血症状的CSD患者临床资料。根据不同的治疗方式分为宫腹腔镜联合修补术组(n=32),宫腔镜电切术组(n=83),阴式修补术组(n=41),左炔诺孕酮宫内缓释系统(LNG-IUS)治疗组(n=52),主要观测指标为阴道出血缩短天数,次要观测指标为治疗有效率、月经满意度等。结果:(1)LNG-IUS组从第6个月起,治疗有效率与其他三组相当(P>0.05);治疗第12个月缩短阴道出血天数更多,月经满意度更优,较其他三组有显著差异(P<0.001);且该组中度CSD和重度CSD两亚组治疗有效率差异无统计学意义(P>0.05)。(2)宫腹腔镜组直接医疗费用最高,其次是宫腔镜组,然后是阴式手术组,LNG-IUS组最低(P<0.05);四组均未发生严重并发症,并发症发生率无显著差异(P>0.05)。结论:四种方式均治疗有效,但LNG-IUS治疗过程简单、经济、并发症轻,对于无生育需求患者可作为首选治疗方式。

Objective:To analyze the effect of four different treatment modalities on patients with cesarean scar diverticulum(CSD)with abnormal vaginal bleeding symptoms,and explore the appropriate treatment methods for such patients.Methods:Clinical data of 208 CSD patients with abnormal vaginal bleeding symptoms admitted from 2016 to 2021 were retrospective reviewed.According to different treatment methods,they were divided into combined repair group by hysteroscopy and laparoscopy(n=32),hysteroscopic electrocution group(n=83),transvaginal repair group(n=41),and evonorgestrel-releasing intrauterine system(LNG-IUS)group(n=52).The main observation index was the shortened days of vaginal bleeding,the secondary observation indicators were effective rate,menstrual satisfaction,etc.Results:(1)From the 6th month after treatment,the effective percentage of treatment in the LNG-IUS group was not different from the other three groups(P>0.05),while more shortened vaginal bleeding days in the 12th months and better menstrual satisfaction were found,with significant difference from the other three groups(P<o.001).There was no significant difference between the two subgroups of moderate CSD and severe CSD(P>0.05).(2)The highest direct medical costs were observed in the combined repair group,followed by the hysteroscopic electrocution group,then the transvaginal repair group,and medical costs were the lowest in the LNG-IUS group(P<o.05).There was no serious complications occurred in the four groups and no significant difference in complication rate among the four groups(P>0.05).Conclusion:All of the four treatments were effective,but LNG-IUS has advantages in simple procedures,lower costs,and less complications,which can be the preferred treatment for patients without fertility needs.