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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (12) : 1243 -1247. doi: 10.3877/cma.j.issn.1674-0785.2022.12.016

临床研究

经阴道子宫憩室修补联合宫腔镜内膜电灼术治疗剖宫产瘢痕憩室的效果分析
戴莉1, 高红艳1,†(), 邢肖肖2, 王清1, 彭妍3, 李沁1, 王慧1   
  1. 1. 213000　江苏常州，苏州大学附属第三医院
    2. 213000　江苏常州，苏州大学附属第三医院超声影像科
    3. 213000　江苏常州，苏州大学附属第三医院病理科
  • 收稿日期:2022-03-29 出版日期:2022-12-15
  • 通信作者: 高红艳
  • 基金资助:
    江苏省医学重点人才基金(FRC201767); 江苏省妇幼健康科研项目(F201724)

Efficacy of transvaginal uterine diverticulum repair combined with hysteroscopic electrocauterization for treatment of previous cesarean scar diverticulum

Li Dai1, Hongyan Gao1,†(), Xiaoxiao Xing2, Qing Wang1, Yan Peng3, Qin Li1, Hui Wang1   

  1. 1. Department of Gynecology and Obstetrics, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
    2. Department of Medical Imaging, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
    3. Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China
  • Received:2022-03-29 Published:2022-12-15
  • Corresponding author: Hongyan Gao
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戴莉, 高红艳, 邢肖肖, 王清, 彭妍, 李沁, 王慧. 经阴道子宫憩室修补联合宫腔镜内膜电灼术治疗剖宫产瘢痕憩室的效果分析[J]. 中华临床医师杂志(电子版), 2022, 16(12): 1243-1247.

Li Dai, Hongyan Gao, Xiaoxiao Xing, Qing Wang, Yan Peng, Qin Li, Hui Wang. Efficacy of transvaginal uterine diverticulum repair combined with hysteroscopic electrocauterization for treatment of previous cesarean scar diverticulum[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(12): 1243-1247.

目的

本研究旨在探讨经阴道子宫憩室修补联合宫腔镜内膜电灼术治疗剖宫产瘢痕憩室的疗效。

方法

选取2017年12月~2021年06月24例剖宫产瘢痕憩室患者为研究对象，采用回顾性研究的方法，分析24例患者的术前临床表现、临床治疗指标（手术时间，术中出血量，发热情况等），子宫憩室缺损大小、子宫肌层残余厚度、月经持续时间，观察患者的治疗效果，与术后1、3、6个月随访月经改善情况及憩室修复情况进行比较。

结果

记录并分析术前及术后残余子宫肌层厚度。经期持续时间在术后第1、3和6个月后比术前均明显缩短（P＜0.05），术后6个月行经三维阴道超声测量残余子宫肌层厚度较术前明显增厚［（0.19±0.16）cm vs.（0.80 ±0.34）cm，P＜0.01］，术后6个月，手术总有效率为87.5%（21/24），3例患者经期延长症状未得到明显改善。

结论

经阴道子宫憩室修补联合宫腔镜内膜电灼术治疗剖宫产瘢痕憩室效果显著，能准确定位憩室位置，充分去除憩室及周围增生内膜，降低复发率，值得临床推广应用。

关键词: 剖宫产瘢痕憩室, 经阴道手术, 宫腔镜手术
Objective

To explore the curative effects of transvaginal uterine diverticulum repair combined with hysteroscopic electrocauterization in the treatment of previous cesarean scar diverticulum (PCSD).

Methods

This is a retrospective study in which 24 PCSD patients were selected from December 2017 to June 2021 as the research subjects. The curative effects were assessed with regard to clinical manifestation, clinical treatment indicators (operation duration, intraoperative blood loss, fever, etc.), uterine diverticulum defect size, thickness of the remaining myometrium (TRM), and menstrual duration. Follow-up visits were carried out to check the therapeutic effect of diverticulum repair and menostaxis improvement one to six months after surgery.

Results

The follow-up visits at one to six months after operation showed that the duration of menstruation was significantly shortened compared with that before surgery (P＜0.05) .The TRM measured by three-dimensional transvaginal ultrasound at 6 months after surgery was significantly thicker than that before surgery [(0.19±0.16) cm vs (0.80±0.34) cm, P＜0.01]. The effective rate of transvaginal uterine diverticulum repair combined with hysteroscopic electrocauterization was 87.5% (21/24), and the symptoms of prolonged menstrual period were not significantly improved in 3 patients.

Conclusion

The curative effects of transvaginal uterine diverticulum repair combined with hysteroscopic electrocauterization in treating PCSD is obvious, because it can locate the cesarean scars accurately, remove the diverticulum and surrounding hyperplastic endometrium fully, and reduce the recurrence rate.

Key words: Previous cesarean scar diverticulum, Transvaginal surgery, Hysteroscopy
表1 患者的基线资料（n=24）
患者的人数 %
年龄（岁） 32.96±4.18（range 25~43）
1次剖宫产史 16 66.7
2次以上剖宫产史 8 33.3
经期前点滴出血 21 87.5
慢性盆腔痛 12 50
复发性阴道炎 6 25
不育 4 16.7
月经经期（天） 13.42±3.17
子宫憩室平均宽度（mm） 1.62±0.59
子宫憩室平均高度（mm） 0.92±0.54
子宫憩室平均深度（mm） 0.88±0.43
术前子宫肌层残余厚度（cm） 0.19±0.16
表2 术中参数及治疗效果（n=24）
相关参数
平均手术时间（min） 75.21±16.84（
x¯
±s 40~105）
平均出血量（ml） 50.21±20.02（
x¯
±s 25~100）
手术费用（元） 10 576.61±1400.13
平均住院天数（天） 5.87±1.23
术后1月经期（天） 9.63±2.60
术后3月经期（天） 8.46±2.45
术后6月经期（天） 8.04±2.40
术后6月子宫肌层残余厚度（cm） 0.80±0.34
图1 术前及术后1、3、6个月经经期情况
表3 手术结局（n=24）
术后时间（月） 显效（%） 有效（%） 无效（%）
1 2（8.3） 12（50.0） 10（41.7）
3 8（33.3） 12（50.0） 4（16.7）
6 14（58.3） 7（29.2） 3（12.5）
1
Bij de Vaate AJ, van der Voet LF, Naji O, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review [J]. Ultrasound Obstet Gynecol, 2014, 43(4): 372-382.
2
Varner M. Cesarean scar imaging and prediction of subsequent obstetric complications [J]. Clin Obstet Gynecol, 2012, 55(4): 988-996.
3
Nezhat C, Falik R, Li A. Surgical management of niche, isthmocele, uteroperitoneal fistula, or cesarean scar defect: a critical rebirth in the medical literature [J]. Fertil Steril, 2017, 107(1): 69-71.
4
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 prevalence and its relation to abnormal uterine bleeding [J]. BJOG, 2014, 121(2): 236-244.
5
Zhou D, Wu F, Zhang Q, et al. Clinical outcomes of hysteroscopy-assisted transvaginal repair of cesarean scar defect [J]. J Obstet Gynaecol Res, 2020, 46(2): 279-285.
6
剖宫产术后子宫瘢痕憩室诊治专家共识 [J]. 中华妇产科杂志, 2019, (3): 145-148.
7
Tahara M, Shimizu T, Shimoura H. Preliminary report of treatment with oral contraceptive pills for intermenstrual vaginal bleeding secondary to a cesarean section scar [J]. Fertil Steril, 2006, 86(2): 477-479.
8
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.
9
张多多, 朱兰. 阴式及腹腔镜途径修补剖宫产瘢痕憩室预后的队列研究 [J]. 实用妇产科杂志, 2018, 34(9): 702-706.
10
钟春燕, 范江涛, 李莉莉, 等. 不同手术方式对剖宫产疤痕憩室治疗效果的Meta分析 [J]. 生殖医学杂志, 2019, 28(3): 237-243.
11
Wang CB, Chiu WW, Lee CY, et al. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position [J]. Ultrasound Obstet Gynecol, 2009, 34(1): 85-89.
12
丁景新, 陈建亮, 张宏伟, 等. 宫腹腔镜联合修补剖宫产术后子宫切口憩室 [J]. 复旦学报(医学版), 2012, 39(5): 506-510.
13
杨静, 曹剑, 杨大震, 等. 经阴道手术治疗剖宫产瘢痕憩室的预后影响因素分析 [J]. 实用妇产科杂志, 2019, 35(9): 706-709.
14
Zhou J, Yao M, Wang H, et al. Vaginal repair of cesarean section scar diverticula that resulted in improved postoperative menstruation [J]. J Minim Invasive Gynecol, 2016, 23(6): 969-978.
15
Ofili-Yebovi D, Ben-Nagi J, Sawyer E, et al. Deficient lower-segment Cesarean section scars: prevalence and risk factors [J]. Ultrasound Obstet Gynecol, 2008, 31(1): 72-77.
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