不同微创手术方式治疗剖宫产术后子宫瘢痕憩室的效果分析

Analysis of the effects of different minimally invasive methods in the treatment of previous cesarean scar defect after cesarean section

目的:探讨不同微创手术方式治疗剖宫产术后子宫瘢痕憩室(previous cesarean scar defect,PCSD)的效果。方法:选取144例PCSD住院病例。根据不同手术方式将其分为阴式手术组(A组,36例),宫腔镜手术组(B组,71例),宫腹腔镜联合手术组(C组,37例)。对比3组病人住院时间、住院费用、术中出血量、术后阴道流血时间、术后病率、术后症状恢复等指标。结果:C组的住院时间和住院费用均高于A组和B组;C组的术后阴道流血时间高于A组和B组,A组的术中出血量高于B组和C组,A组的术后病率高于B组和C组;B组和C组治疗效果显著优于A组,差异均有统计学意义(P<0.05~P<0.01)。结论:3种不同手术方式各有不同的优势且都具有一定的临床效果,阴式手术方式优点是住院时间短、住院费用较低、术后阴道流血时间较短,而缺点是病人术中出血量相对多、术后病率发生高,且术后治愈率相对低;宫腔镜手术方式优点在于住院时间短、住院费用低、术后阴道流血时间短、发生术后病率相对低,且术后治愈率高;宫腹腔镜联合手术方式优点在于术后治愈率最高,但其缺点在于住院费用高,住院时间和术后阴道流血时间长。

Objective:To investigate the effects of different minimally invasive surgical methods in the treatment of previous cesarean scar defect(PCSD)after cesarean section.Methods:One hundred and forty-four hospitalized patients with PCSD were selected.According to different surgical methods,the patients were divided into the vaginal surgery group(group A,36 cases),hysteroscopic surgery group(group B,71 cases)and hysteroscopic combined with surgery group(group C,37 cases).The length of hospital stay,hospitalization cost,intraoperative blood loss,postoperative vaginal bleeding time,postoperative incidence rate of disease,postoperative symptom recovery and other indicators were compared among three groups.Results:The length and cost of hospitalization in group C were higher than those in group A and group B;the duration of postoperative vaginal bleeding in group C was higher than that in group A and group B,the amount of intraoperative bleeding in group A was higher than that in group B and group C,and the postoperative incidence rate of disease in group A was higher than that in group B and group C;the therapeutic effects of group B and group C were significantly higher than that in group A;and the differences of which were statistically significant(P<0.05 to P<0.01).Conclusions:The three different surgical methods have different advantages and certain clinical effects.The short hospitalization time,low hospitalization cost and short postoperative vaginal bleeding time are the advantages of vaginal surgery,while its disadvantages are relatively large amount of intraoperative blood loss,high postoperative incidence rate of disease rate and low postoperative cure rate.The short hospitalization time,low hospitalization cost,short postoperative vaginal bleeding time,relatively low postoperative incidence rate of disease and high postoperative cure rate are the advantages of hysteroscopic surgery.The highest postoperative cure rate is the advantage of hysteroscopy combined with surgery,but its disadvantages are high hospitalization cost,hospital stay and long postoperative vaginal bleeding time.