基于发病机制及病理变化治疗剖宫产瘢痕缺损新术式疗效分析

Efficacy analysis of a new surgical method for cesarean scar defeet based on pathogenesis and pathological changes

目的探讨基于发病机制及病理变化治疗剖宫产瘢痕缺损新术式的疗效。方法选取郑州大学第一附属医院2020年1月至2022年12月收治的具有手术指征的剖宫产瘢痕缺损患者51例,采用新术式,针对发病机制即剖宫产切口部位局部肌层的连续性中断和缺损形成的瘢痕缺损及继发的病理改变如瘢痕缺损处经血潴留、排出不畅引起的继发炎性反应、充血、异形血管、息肉形成等,采用宫腹腔镜联合准确定位瘢痕缺损部位缺陷肌层,修复重建局部缺陷,并处理异形血管、息肉等继发性改变。分析术中、术后指标,随访术后症状改善、缺损变化、总体疗效及妊娠情况。结果经期持续时间术前为(13.9±2.5)d,术后3个月为(7.2±1.8)d,术后较术前对比有显著改善,差异有统计学意义(P<0.05)。残余子宫肌层厚度术前为(1.8±0.7)mm,术后3个月为(6.4±2.2)mm,术后较术前差异有统计学意义(P<0.05)。术后82.4%(42/51)患者治愈,经期恢复正常;13.7%(7/51)患者有效,经期较前缩短;3.9%(2/51)患者无效,术后经期较前无变化。症状学评估手术总有效率为96.1%(49/51)。术后仅需避孕3个月,半年至2年内的妊娠率达61.3%(19/31)。结论基于发病机制及病理变化治疗剖宫产瘢痕缺损修复新术式,可明显改善患者临床症状,术后避孕时间短,是治疗剖宫产瘢痕缺损的安全有效的方式。

Objective To analyze the efficacy of a new surgical method based on pathogenesis and pathological changes in the treatment of cesarean scar defect(CSD).Methods A total of 51 CSD patients with surgical indications were treated with a new surgical method in the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2022.Regarding the pathogenesis,i.s.,the scar defect caused by myometrial discontinuity and defect and secondary pathological changes such as secondary inflammatory reaction,congestion,abnormal blood vessels and polyps due to retention of menses and poor menstrual discharge,the laparoscopy combined with hysteroscopy was used to repair and reconstruct the defective muscle layer,and dealing with secondary changes such as abnormal blood vessels and polyps.The intraoperative and postoperative indexes were analyzed,and the postoperative menstrual duration,improvement of diverticulum muscle thickness,overall curative effect,and pregnancy were followed up.ResulstsThe duration of menstruation before and three months after operation was(13.9+2.5)days and(7.2±1.8)days respectively,indicating the postoperative menstrual period was significantly improved compared with that before operation(P<0.05).The thickness of residual muscle layer was(1.8+0.7)mm before operation and(6.4±2.2)mm at three months after operation.The thickness of muscle layer was thicker than that before operation(P<0.05).After operation,82.4%(42/51)of the patients were cured,and the menstrual period returned normal;13.7%(7/51)of the patients were effective,and the menstrual period was shorter than before;3.9%(2/51)were ineffective,and there was no change in the menstrual period after operation.The total effective rate of symptomatic evaluation was 96.1%(49/51).Contraception was only needed for three months after operation,and the pregnancy rate within half a year to two years was 61.3%(19/31).Conclusion The new surgical method to treat CSD based on the pathogenesis and pathological changes can significantly improve the clinical symptoms of patients and the postoperative contraceptive time is thort,so it is a safe and effective way to treat CSD.