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

doi:10.3877/cma.j.issn.1674-0785.2022.12.016

Abstract

Abstract:

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

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.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2022.12.016

https://zhlcyszz.cma-cmc.com.cn/EN/Y2022/V16/I12/1243

Figures/Tables 4

	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

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

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

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）

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