[1]肖洁,周健,梁丽,等.宫腔镜憩室内膜去除联合腹腔镜瘢痕处缺损加固治疗剖宫产瘢痕憩室临床多指标回顾分析[J].徐州医科大学学报,2020,40(11):812-816.[doi:10.3969/j.issn.2096-3882.2020.11.007]
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宫腔镜憩室内膜去除联合腹腔镜瘢痕处缺损加固治疗剖宫产瘢痕憩室临床多指标回顾分析()
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《徐州医科大学学报》[ISSN:2096-3882/CN:32-1875/R]

卷:
40
期数:
2020年11期
页码:
812-816
栏目:
出版日期:
2020-11-25

文章信息/Info

Title:
Clinical analysis of hysteroscopic diverticulum removal combined with laparoscopic scar defect reinforcecement in the treatment of caesarean section scar diverticulum
作者:
肖洁 周健 梁丽 蔡莉 方媛媛 杨晓 黄辉 许晨琛 董秀娟
徐州市妇幼保健院妇科,江苏 徐州 221009;徐州市妇幼保健院病案科;徐州市妇幼保健院超声科
关键词:
剖宫产瘢痕憩室 腹腔镜 宫腔镜 瘢痕缺损加固 憩室内膜去除
DOI:
10.3969/j.issn.2096-3882.2020.11.007
文献标志码:
A
摘要:
目的 探寻较为有效的手术治疗剖宫产瘢痕憩室的方式、方法.方法 回顾性分析徐州市妇幼保健院确诊剖宫产瘢痕憩室60例患者的临床资料,均采取宫腔镜憩室内膜去除联合腹腔镜瘢痕处缺损加固的术式.术后1个月随访手术情况;术后3、6、12个月随访月经期,超声测量子宫下段瘢痕处最薄肌层的厚度及剖宫产瘢痕憩室的容积;术后24个月随访宫内妊娠例数.结果 60例患者术后均无并发症;有效51例(85%),无效9例(15%),复发3例(5.0%);术后3、6、12个月月经期中位数分别为8.1、8.2、8.5 d,较术前(13.0 d)明显缩短(P<0.05);术后3、6、12个月剖宫产瘢痕憩室的容积中位数分别为0.42、0.37、0.54 cm3,明显小于治疗前(P<0.05);术后3、6、12个月剖宫产瘢痕憩室底部到浆膜层最薄肌层厚度中位数分别为0.25、0.25、0.24 cm,大于治疗前(P<0.05).结论 宫腔镜憩室内膜去除联合腹腔镜瘢痕处缺损加固治疗剖宫产瘢痕憩室手术既可以缩短憩室患者的月经期,又可以有效修复子宫下段瘢痕处解剖结构,且不破坏憩室部位肌层组织的连续性,还可增加肌层厚度,减少再次妊娠子宫破裂的风险.
Abstract:
ob<x>jective To explore the therapeutic effect of hysteroscopic diverticulum intima removal combined with laparoscopic scar defect reinforcement on cesarean scar diverticulum.Methods 60 cases of cicatricial diverticulum of cesarean section diagnosed in our hospital were analyzed retrospectively.Follow-up visits were performed 1,3,6 and 12 months after surgery and then annually. One month after operation, the patients were followed up for the healing of the incision. The menstrual cycle was measured three months, six months and 12 months after operation. The thickness of the thinnest myometrium and the volume of uterine diverticulum were measured at 3, 6 and 12 months after operation. Cases of intrauterine pregnancy followed up 24 months after operation. Results There were no complications in 60 follow-up patients. Of 60 women, 51 (85%, 51/60) women were cured; 9 (15%, 9/60) cases were invalid; 3(5%, 3/60) cases recurred. The median menstrual period of 3 months, 6 months and 12 months after operation was 8.1 days (4.00-18.00 days), 8.2 days (4.00-20.00 days) and 8.5 days (5.00-20.00 days), which was significantly shorter than that before operation (P < 0.05). The median volume of cesarean scar diverticulum was 0.42 cm3 (0.04-14.40 cm3), 0.37 cm3 (0.06-3.84 cm3), 0.54 cm3 (0.101-4.61 cm3), which was significantly smaller than that before treatment (P < 0.05). The median thickness from the bottom of the scar diverticulum to the thinnest sarcoplasmic la<x>yer was 0.25cm (0.15-0.50cm), 0.25cm (0.15-0.50cm), 0.24cm (0.15-0.50cm), which was larger than that before treatment (P < 0.05).Conclusions Hysteroscopic diverticulum intima removal combined with laparoscopic scar reinforcement for cesarean scar diverticulum surgery can not only alleviate the menstrual condition of diverticulum patients, but also effectively repair the isthmus anatomy, and do not damage the continuity of myometrium tissue in diverticulum, increase myometrium thickness, and reduce the risk of uterine rupture in the second pregnancy.

相似文献/References:

[1]谢志远,张亮,龚龙波,等.改良腹腔镜低位直肠吻合方法对肛门直肠功能的影响[J].徐州医科大学学报,2017,(10):631.
 XIE Zhiyuan,ZHANG Liang,GONG Longbo,et al.Study on the effects of modified laparoscopic low rectal anastomosison anal-rectal function[J].Journal of Xuzhou Medical University,2017,(11):631.

更新日期/Last Update: 2020-12-15