宫腔镜电凝术与阴式手术治疗子宫切口瘢痕憩室的疗效对比
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摘要
目的探讨并比较宫腔镜电凝术与阴式手术治疗子宫切口瘢痕憩室的临床疗效。方法采用回顾性研究的方法,选取2013年1月至2017年1月上海市第八人民医院收治的58例子宫切口瘢痕憩室并进行手术的患者为研究对象。根据治疗方法的不同,将患者分为宫腔镜电凝术组(n=26)和阴式手术组(n=32)。比较两组患者的术中出血量、手术时间、住院时间,并随访患者术后1～6个月的月经改善情况。结果宫腔镜电凝术组患者术中出血量、手术时间和住院时间(5. 98±1. 03) ml、(35. 43±9. 41) min、(4. 98±1. 21) d均显著低于阴式手术组(25. 88±5. 12) ml、(76. 33±11. 09) min、(7. 02±1. 76) d,差异有统计学意义(P <0. 05)。两组患者术后1个月的月经恢复情况73. 1%(19/26)vs. 62. 5%(20/32)差异无统计学意义(P> 0. 05);术后6个月时,阴式手术组月经恢复比率93. 75%(30/32)显著高于宫腔镜电凝术组76. 9%(20/26),差异有统计学意义(P <0. 05)。结论宫腔电凝术在治疗子宫切口瘢痕憩室中具有创伤小、恢复快的优点,而阴式手术则治疗更彻底。因此,在临床工作中建议根据患者需求进行选择。
Objective To investigate and compare efficacy of hysteroscopic electrocoagulation and vaginal surgery in treatment of uterine scar diverticulum. Methods 58 cases of uterine scar diverticulum and surgery from January 2013 to January 2017 in our center were retrospectively selected and divided into hysteroscopic electrocoagulation group( n = 26) and vaginal surgery group( n = 32). Bleeding volume,operation time,hospital stay,and follow-ups of patients after 1 month and 6 months regarding menstrual status were recorded and compared. Results The bleeding volume,operation time and hospitalization time of hysteroscopy electrocoagulation group( 5. 98 ± 1. 03) ml、( 35. 43 ± 9. 41) min、( 4. 98± 1. 21) were significantly lower than in vaginal operation group( 25. 88 ± 5. 12) ml,( 76. 33 ± 11. 09) min,( 7. 02 ± 1. 76) d( P < 0. 05).There was no significant difference in post-operation menstrual recovery at 1 month between two groups [73. 1%( 19/26) vs 62. 5%( 20/32) ]( P > 0. 05). At 6 months after operation,menstrual recovery rate of vaginal operation group 93. 75%( 30/32) was significantly higher than in hysteroscopy electrocoagulation group 76. 9%( 20/26)( P < 0. 05). Conclusion Uterine electrocoagulation has the advantages of less trauma and faster recovery in treatment of uterine incision scar diverticulum,while vaginal surgery has more satisfactory menstrual recovery,the choice of which calls for discretion.
Objective To investigate and compare efficacy of hysteroscopic electrocoagulation and vaginal surgery in treatment of uterine scar diverticulum. Methods 58 cases of uterine scar diverticulum and surgery from January 2013 to January 2017 in our center were retrospectively selected and divided into hysteroscopic electrocoagulation group( n = 26) and vaginal surgery group( n = 32). Bleeding volume,operation time,hospital stay,and follow-ups of patients after 1 month and 6 months regarding menstrual status were recorded and compared. Results The bleeding volume,operation time and hospitalization time of hysteroscopy electrocoagulation group( 5. 98 ± 1. 03) ml、( 35. 43 ± 9. 41) min、( 4. 98± 1. 21) were significantly lower than in vaginal operation group( 25. 88 ± 5. 12) ml,( 76. 33 ± 11. 09) min,( 7. 02 ± 1. 76) d( P < 0. 05).There was no significant difference in post-operation menstrual recovery at 1 month between two groups [73. 1%( 19/26) vs 62. 5%( 20/32) ]( P > 0. 05). At 6 months after operation,menstrual recovery rate of vaginal operation group 93. 75%( 30/32) was significantly higher than in hysteroscopy electrocoagulation group 76. 9%( 20/26)( P < 0. 05). Conclusion Uterine electrocoagulation has the advantages of less trauma and faster recovery in treatment of uterine incision scar diverticulum,while vaginal surgery has more satisfactory menstrual recovery,the choice of which calls for discretion.
引文
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[9]赵倩,郭瑞霞.剖宫产瘢痕憩室经阴道手术治疗[J].中国实用妇科与产科杂志,2018,34(8):872-875.
[10]王细拉.经宫腹腔镜联合手术切除治疗剖宫产术后子宫切口瘢痕憩室的疗效[J].中国妇幼保健,2017,32(17):4277-4279.
[2]杜永强.造影增强磁共振检查对于剖宫产后切口憩室诊断的临床价值[J].临床和实验医学杂志,2018,17(10):1099-1101.
[3]王马列,梁润彩.剖宫产术后子宫切口憩室治疗进展[J].中国实用妇科与产科杂志,2013,29(5):390-392.
[4] Chauhan SP,Magann EF,Wiggs CD,Barrilleaux PS,et al. Pregnancy after classic cesarean delivery[J]. Obstet Gynecol,2002,100(5 Pt 1):946-950.
[5] Yao M,Chen H,Tao J,et al. Clinical research of transvaginal repair of cesarean scar diverticulum[J]. Zhonghua Fu Chan Ke Za Zhi,2015,50(7):500-504.
[6] Luo L,Niu G,Wang Q,et al. Vaginal repair of cesarean section scar diverticula[J]. J Minim Invasive Gynecol,2012,19(4):454-458.
[7] Chen Y,Chang Y,Yao S. Transvaginal management of cesarean scar section diverticulum:a novel surgical treatment[J]. Med Sci Monit,2014,20:1395-1399.
[8] Abacjew-Chmylko A,Wydra DG,Olszewska H. Hysteroscopy in the treatment of uterine cesarean section scar diverticulum:A systematic review[J]. Adv Med Sci,2017,62(2):230-239.
[9]赵倩,郭瑞霞.剖宫产瘢痕憩室经阴道手术治疗[J].中国实用妇科与产科杂志,2018,34(8):872-875.
[10]王细拉.经宫腹腔镜联合手术切除治疗剖宫产术后子宫切口瘢痕憩室的疗效[J].中国妇幼保健,2017,32(17):4277-4279.