经阴道手术治疗剖宫产瘢痕憩室的预后影响因素分析

Prognostic Factors Analysis of Trans-vaginal Repair of Cesarean Scar Defect

目的:探讨经阴道手术治疗剖宫产瘢痕憩室(CSD)的疗效及其预后影响因素。方法:回顾性分析2016年9月至2018年4月在南京医科大学附属妇产医院经阴道手术治疗的55例CSD患者的临床资料,随访术后恢复情况并比较影响手术疗效的因素。结果:①术后3个月B超检测憩室完全消失率为74.55%(41/55),术后6个月78.18%(43/55)的患者月经期缩短至10天以内。②子宫前位或中位的患者术后愈合良好(术后经期≤10天)率(87.88%)高于子宫后位的患者(63.64%)(χ~2=4.548,P=0.033);愈合良好组的术前憩室深度(8.28±1.42 mm)小于愈合不良组患者的术前憩室深度(9.58±2.61 mm),差异有统计学意义(t=-2.302,P=0.025);愈合良好组的残余肌层厚度(3.31±1.22 mm)大于愈合不良组(2.42±0.85 mm),差异有统计学意义(t=2.384,P=0.021)。③多因素分析结果示子宫位置、术前憩室深度和残余肌层厚度是影响手术疗效的独立因素(P<0.05)。结论:经阴道手术治疗CSD能够改善患者症状,子宫后位、憩室深度及残余肌层厚度是手术修复效果的独立影响因素。

Objective:To evaluate the efficacy of trans-vaginal repair of cesarean scar defect and explore the prognostic factors.Methods:From Sept.2016 to Apr.2018,all of the 55 patients′data with cesarean scar defect who underwent trans-vaginal repair surgery were studied retrospectively and post-operation results were followedto analysis the possible influence factors.Results:①A post-operative menstruation period lasting no more than 10 days was achieved in 78.18%(43/55)of patients 6 months after surgery,and defect was disappeared on trans-vaginal ultrasonography in 74.55%(41/55)of patients 3 months after surgery.②The rate of post-operative menstruation period≤10 days in patients with straight or anteposition uterus was higher than that in patients with retroposition uterus(87.88%vs 63.64%,χ~2=4.548,P=0.033).Compared with patients whose post-operative menstruation period lasting more than 10 days,the depth of defect was smaller(8.28±1.42 mm vs 9.58±2.61 mm,t=-2.302,P=0.025)and the residual uterine thickness was thicker(3.31±1.22 mm vs 2.42±0.85 mm,t=2.384,P=0.021)in patients with a menstruation period no more than 10 days after surgery.③Logistic test showed that uterine position,depth of defect and residual uterine thickness were all risk factors of the effect of operation(P<0.05).Conclusions:Trans-vaginal repair could significantly alleviate symptoms,and the position of uterus,depth of defect and residual uterine thickness were possible factors influencing the outcome.