生殖医学杂志2017，Vol.26Issue(4)：331-335,5.DOI:10.3969/j.issn.1004-3845.2017.04.008
剖宫产子宫瘢痕憩室52例的临床诊治分析
Clinically diagnostic and therapeutic analysis of 52 patients with cesarean scar
摘要
Abstract
Objective:To explore the diagnostic significance of sonohysterography for the patients with previous cesarean scar defect(PCSD)and clinical effect of treatment by different minimally invasive surgery.Methods:A total of 52 patients who were treated surgically because of previous cesarean scar defect in Shengjing Hospital from March 2012 to October 2015.All the patients had transvaginal ultrasound and sonohysterography examination,and their related indicators of diverticula were measured.The patients were divided two groups:The patients underwent hysteroscopic PCSD repair surgery in group A (n=32);and the patients underwent combined of hysteroscopic and laparoscopic PCSD resection and uterine repair surgery in group B (n=20).The operation time,bleeding volume,postoperative hospital stay,and the clinical effect of different surgical method were compared between the two groups.Results:The diagnostic accuracy rate for PCSD is 100% by sonohysterography,while that is 80.8% by tansvaginal ultrasound.The length of PCSD was (9.3±0.5) mm when the irregular vaginal bleeding duration was more than 5 days,while the length was (7.6±0.6) mm when the bleeding duration was ≤5 days.The bleeding duration was significantly different between the two groups (P<0.05).The depth of posterior uterus [(7.5±0.4) vs. (5.9±0.4)mm] was significantly different with that of anterior uterus (P<0.05).The operation time,bleeding volume and postoperative hospital stay in group A were significantly less than those of group B (P<0.05).There was no surgical complications occurred in the two groups.The effective rate of group A (90.6%) was not significantly different with that of group B (95%)(P>0.05).Conclusions:The sonohysterography has higher diagnostic accuracy for previous cesarean scar defect,which can be used as an important clinical auxiliary examination method.The length of PCSD may associate with the severity of symptoms.PCSD is more likely to happen in posterior uterus compared to anterior uterus.Hysteroscopy surgery or combined of hysteroscopy and laparoscopy surgery can achieved good clinically therapeutic effect.The hysteroscopy surgery is a kind of method with simpleness,quick recovery and small trauma,which is suitable for the patients without fertility requirement.The best choice is the combined of hysteroscopy and laparoscopy surgery,which can better repair previous cesarean scar defect,for patients with fertility requirements.关键词
剖宫产/瘢痕憩室/宫腔超声造影/宫腔镜/腹腔镜Key words
Cesarean section/cesarean scar defect/Sonohysterography/Hysteroscopy/Laparoscopy引用本文复制引用
张宁宁,王光伟,杨清..剖宫产子宫瘢痕憩室52例的临床诊治分析[J].生殖医学杂志,2017,26(4):331-335,5.基金项目
人口与健康科技攻关专项(F15-139-9-33) （F15-139-9-33）
