探讨宫腔镜及宫、腹腔镜联合治疗剖宫产术后子宫切口憩室(PCSD)的临床疗效。

选择2011年1月至2016年1月，于成都市妇女儿童中心医院通过超声和(或)宫腔镜检查确诊为PCSD，并于本院接受手术治疗的50例PCSD患者为研究对象。根据这50例PCSD患者接受修补手术的方式，将其分别纳入宫腔镜组(n＝18，宫腔镜下PCSD修补术)与联合治疗组(n＝32，宫、腹腔镜下联合PCSD修补术)。采用回顾性分析方法，对2组患者的术中出血量、手术时间、术后住院时间，以及术后并发症发生情况、PCSD修复情况和月经周期改善情况进行相关统计学分析。2组患者的年龄、剖宫产术分娩次数、月经期时间及术前PCSD深度等基本临床资料比较，差异均无统计学意义(P>0.05)。

①宫腔镜组患者术中出血量、手术时间及术后住院时间，显著少于或短于联合治疗组患者，并且差异均有统计学意义(t＝－6.606、－10.525、－10.437，P<0.001)。②本研究50例PCSD患者术后均恢复良好，无修补术相关并发症发生。术后6个月时，宫腔镜组和联合治疗组患者月经期改善有效率分别为88.9%(16/18)与87.5%(28/32)，二者比较，差异无统计学意义(χ²＝0.021，P＝0.885)。宫腔镜组与联合治疗组患者PCSD修复有效率分别为94.4%(17/18)与93.8%(30/32)，二者比较，差异亦无统计学意义(χ²＝0.010，P＝0.921)。

宫腔镜下PCSD修补术及宫、腹腔镜下联合PCSD修补术，均可有效改善PCSD患者月经期延长症状，并有效修补PCSD。对于PCSD患者手术治疗方法的选择，应根据患者具体病情，选择最为合适的手术治疗方法。

To evaluate clinical effects of hysteroscopy and hysteroscopy combined with laparoscopy in repairing previous cesarean scar diverticulum (PCSD).

A total of 50 cases of patients who were diagnosed as PCSD through ultrasound or hysteroscopy and treated in Chengdu Women & Children′s Central Hospital from January 2011 to January 2016 were selected as research subjects. They were divided into hysteroscopy group (n=18, received hysteroscopic repair) and combined therapy group (n=32, received hysteroscopic repair combined with laparoscopic repair) according to the treatment methods. Intraoperative bleeding volume, operation duration, postoperative hospitalization time, complications, repair of PCSD and the improvement of menstrual period of two groups were retrospectively analyzed and compared by statistical methods. There were no statistical differences between two groups in the age, times of cesarean delivery, menstrual period and preoperative PCSD depth (P>0.05).

①The intraoperative bleeding volume, operation duration and postoperative hospitalization time of hysteroscopy group all were better than those of combined therapy group, and all the differences were statistically significant (t=-6.606, -10.525, -10.437; P<0.001). ②All the 50 cases of PCSD patients were well recovered after surgery, and no complications related with repair surgery occurred. After 6 months of surgery, the menstruation period improvement rates were 88.9% (16/18) and 87.5% (28/32) in hysteroscopy group and combined therapy group, respectively, and the difference between the two groups had no statistical significance (χ²=0.021, P=0.885). The PCSD improvement rates were 94.4% (17/18) and 93.8% (30/32) in hysteroscopy group and combined therapy group, respectively, and the difference between the two groups had no statistical significance (χ²=0.010, P=0.921).

Both of hysteroscopy and hysteroscopy combined with laparoscopy have good effects in repairing PCSD and can markedly improve the clinical symptoms of patients. Different measures should be given to different PCSD patients according to the patients′ individual situations.