腹腔镜折叠对接缝合联合宫腔镜憩室开渠法治疗剖宫产瘢痕憩室的疗效

Efficacy of laparoscopic folding suture combined with hysteroscopic iverticulum incision in the treatment of cesarean scar diverticulum

目的探讨腹腔镜折叠对接缝合联合宫腔镜憩室开渠术治疗剖宫产瘢痕憩室(CSD)的疗效。方法选择2018年5月至2022年12月在南京医科大学附属淮安第一医院因CSD接受手术治疗86例患者的临床病例资料为研究对象。根据手术治疗方式不同,将其分为实验组(n=56,接受腹腔镜下折叠对接缝合法联合宫腔镜憩室开渠法者)和对照组(n=30,接受腹腔镜下折叠对接缝合法者)。回顾性分析2组患者一般临床资料、围手术期相关指标、术前及术后6个月经期持续时间,以及治疗总有效率等。本研究所遵循的程序符合南京医科大学附属淮安第一医院医学伦理委员会制定的标准,得到该委员会批准(审批文号:YX-P-2018-012-01),并与患者本人或其家属签署临床研究知情同意书。结果①2组CSD患者年龄与CSD残余肌层处厚度、深度及剖宫产次数、子宫位置构成比等一般临床资料比较,差异均无统计学意义(P>0.05)。②2组患者术中出血量、总住院时间、术后住院时间、术后留置尿管时间和术后排气时间比较,差异均无统计学意义(P>0.05)。③实验组与对照组CSD患者术后平均经期分别为(7.9±3.2)d与(8.4±3.2)d,均明显短于术前的(15.2±5.7)d与(12.6±5.1)d,差异均有统计学意义(t=9.59、4.79,P<0.001)。④实验组患者的治疗总有效率为83.9%(47/56),显著高于对照组的63.3%(19/30),并且差异有统计学意义(χ^(2)=4.64,P=0.031)。结论腹腔镜折叠对接缝合联合宫腔镜憩室开渠法治疗CSD患者具有临床效果确切、可保留子宫完整性、缩短经期的优点,适宜临床推广。

Objective To explore the efficacy of laparoscopic folding suture combined with hysteroscopic iverticulum incision in the treatment of cesarean scar diverticulum(CSD).Methods A total of 86 patients with CSD in the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University from May 2018 to December 2022 were selected into this study.They were randomly divided into experimental group(n=56,patients received laparoscopic folding suture combined with hysteroscopic hysteroscopy diverticulum incision)and control group(n=30,patients received laparoscopic folding suture)according to the different surgical method.The general clinical data,perioperative related indicators,preoperative and post-operative menstruation period,and the total treatment response rate of two groups were retrospectively analyzed.This study was approved by the Ethics Committee of the Affiliated Huai′an No.1 People′s Hospital of Nanjing Medical University(Approve No.YX-P-2018-012-01).The patients or their family members signed the clinical research informed consent.Results①There were no statistically significant differences between two groups of general clinical data such as age,residual uterine thickness,depth of defect,number of caesarean sections and uterine position composition ratio(P>0.05).②There were no statistically significant differences in intraoperative blood loss,total hospital stay,postoperative hospital stay,postoperative indwelling catheter time,and postoperative exhaust time between two groups(P>0.05).③The mean postoperative menstrual period in the experimental group was(7.9±3.2)d,significantly shorter than that of preoperative menstrual period[(15.2±5.7)d].The mean postoperative menstrual period in control group was(8.4±3.2)d,also significantly shorter than that of preoperative menstrual period of(12.6±5.1)d.The above differences between two groups were all statistically significant(t=9.59,4.79;P<0.001).④The total effective rate of experimental group was 83.9%(47/56),significantly higher than 63.3%(19/30)in control group,the difference between two groups was statistically significant(χ^(2)=4.64,P=0.031).Conclusions Laparoscopic folding suture combined with hysteroscopic iverticulum incision has the advantages of definite clinical effects,preserve uterine integrity,shorten menstrual period,which is suitable for clinical promotion.