Clinical effects analysis of hysteroscopy and hysteroscopy combined with laparoscopy in repairing previous cesarean scar diverticulum

doi:10.3877/cma.j.issn.1673-5250.2017.03.017

Objective

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

Methods

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).

Results

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).

Conclusions

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.

Key words: Hysteroscopy, Laparoscopy, Repair, Previous cesarean scar diverticulum, Female

表1 2组剖宫产术后子宫切口憩室患者术中出血量、手术时间、术后住院时间比较(±s)

组别	例数	术中出血量(mL)	手术时间(min)	术后住院时间(d)
宫腔镜组	18	14.7±4.1	23.6±6.9	3.1±0.5
联合治疗组	32	61.1±34.2	92.3±29.9	5.3±0.7
t值	?	－6.606	－10.525	－10.437
P值	?	<0.001	<0.001	<0.001

表1 2组剖宫产术后子宫切口憩室患者术中出血量、手术时间、术后住院时间比较(±s)

组别	例数	术中出血量(mL)	手术时间(min)	术后住院时间(d)
宫腔镜组	18	14.7±4.1	23.6±6.9	3.1±0.5
联合治疗组	32	61.1±34.2	92.3±29.9	5.3±0.7
t值	?	－6.606	－10.525	－10.437
P值	?	<0.001	<0.001	<0.001

表2 2组剖宫产术后子宫切口憩室患者修补术后月经期改善情况及剖宫产术后子宫切口憩室修复情况比较

组别	例数	术前月经期(d, ±s)	术后月经期(d，±s)	月经期改善有效率[例数(%)]	PCSD修复有效率[例数(%)]
宫腔镜组	18	13.7±1.8	7.7±2.6	16(88.9)	17(94.4)
联合治疗组	32	14.4±3.3	7.3±2.0	28(87.5)	30(93.8)
检验值	?	t＝0.807	t＝0.438	χ²＝0.021	χ²＝0.010
P值	?	0.458	0.534	0.885	0.921

表2 2组剖宫产术后子宫切口憩室患者修补术后月经期改善情况及剖宫产术后子宫切口憩室修复情况比较

组别	例数	术前月经期(d, ±s)	术后月经期(d，±s)	月经期改善有效率[例数(%)]	PCSD修复有效率[例数(%)]
宫腔镜组	18	13.7±1.8	7.7±2.6	16(88.9)	17(94.4)
联合治疗组	32	14.4±3.3	7.3±2.0	28(87.5)	30(93.8)
检验值	?	t＝0.807	t＝0.438	χ²＝0.021	χ²＝0.010
P值	?	0.458	0.534	0.885	0.921

[1]	侯磊，李光辉，邹丽颖，等. 全国剖宫产率及剖宫产指征构成比调查的多中心研究[J]. 中华妇产科杂志，2014, 49(10): 728-735.
[2]	van der Voet LF, Bij de Vaate AM, Veersema S, et al. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche revalence and its relation to abnormal uterine bleeding[J]. BJOG, 2014, 121(2): 236-244.
[3]	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.
[4]	Chen YQ, Chang YJ, Yao SZ. Transvaginal management of cesarean scar section diverticulum: a novel surgical treatment[J]. Med Sci Monit, 2014, 20(9): 1395-1399.
[5]	Li C, Tang S, Gao X, et al. Efficacy of combined laparoscopic and hysteroscopic repair of post-cesarean section uterine diverticulum: a retrospective analysis[J]. Biomed Res Int, 2016: 1765624.
[6]	沈瑶，林建华，林其德，等. 我国部分地区剖宫产率影响因素和指征分析[J]. 实用妇产科杂志，2011, 27(3): 183-187.
[7]	Istre O, Springborg H. Laparoscopic repair of uterine scar after C section[J]. J Minim Invasive Gynecol, 2011, 18(6): S90.
[8]	Klemm P, Koehler C, Mangler M, et al. Laparoscopic and vaginal repair of uterine scar dehiscence following cesarean section as detected by ultrasound[J]. J Perinat Med, 2005, 33(4): 324-331.
[9]	Florio P, Filippeschi M, Moncini I, et al. Hysteroscopic treatment of the cesarean-induced isthmocele in restoring infertility[J]. Curr Opin Obstet Gynecol, 2012, 24(3): 180-186.
[10]	Marotta ML, Donnez J, Squifflet J, et al. Laparoscopic repair of post-cesarean section uterine scar defects diagnosed in nonpregnant women[J]. J Minim Invasive Gynecol, 2013, 20(3): 386-391.
[11]	郭银树，段华，张颖，等. 宫腔镜联合B超及腹腔镜在剖宫产切口憩室诊治中的应用[J]. 中国微创外科杂志，2011, 11(11): 1019-1021.
[12]	Chang Y, Tsai EM, Long CY, et al. Resectoscopic treatment combined with sonohysterographic evaluation of women with postmenstrual bleeding as a result of previous cesarean delivery scar defects[J]. Am J Obstet Gynecol, 2009, 200(4): 370. e1-e4.
[13]	Mah MW, Pyper AM, Oni GA, et al. Impact of antibiotic prophylaxis on wound infection after cesarean section in a situation of expected higher risk[J]. Am J Infect Control, 2001, 29(2): 85-88.
[14]	Api M, Boza A, Gorgen H, et al. Should cesarean scar defect be treated laparoscopically? A case report and review of the literature[J]. J Minim Invasive Gynecol, 2015, 22(7): 1145-1152.
[15]	Nirgianakis K, Oehler R, Mueller M. The Rendez-vous technique for treatment of caesarean scar defects: a novel combined endoscopic approach[J]. Surg Endosc, 2016, 30(2): 770-771.
[16]	Ding JX, Chen JL, Zhang HW, et al. Hysteroscopic examination and laparoscopic repair of uterine scar defect after cesarean section[J]. Fudan Univ J Med Sci, 2012, 39(5): 506-510.

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