30例宫腹腔镜联合修补剖宫产后子宫切口瘢痕憩室临床分析

发布时间：2019-01-19 15:42

【摘要】：[目的]剖宫产后子宫切口瘢痕憩室,又称剖宫产子宫切口愈合不良,是剖宫产术后常见的并发症之一,目前针对瘢痕憩室的诊断与治疗,无统一标准,本研究拟探讨宫腹腔镜联合修补术对剖宫产后子宫切口瘢痕憩室的临床疗效。[方法]回顾性分析2013至2016年于浙江大学附属第二医院确诊为剖宫产后子宫瘢痕憩室,接受宫腹腔镜联合手术的患者58例,进行术前、术中评估,以及术后疗效及妊娠情况随访,30例有完整随访资料与结果,对这30例患者进行回顾性分析。[结果]所有患者术前进行子宫MRI检查,与宫腔镜诊断符合率100%。宫腹腔镜联合修补术对缓解经期延长症状的有效率可达到96.7%(29/30),完全有效率可达到80%(24/30)。术后6月患者复查阴道超声或子宫磁共振,均提示子宫切口瘢痕较前缩小或肌层较前增厚(P0.01,有显著性差异)。其术后经期平均为7.93±2.20天(P0.01,有显著性差异)。剖产1次的患者14例(46.7%),术后经期平均为7.07±0.99天(P0.01,有显著性差异),剖产2次的患者16例(53.3%),术后经期平均为8.69±2.68天(P0.01,有显著性差异)。囊状憩室的术后经期平均为7.2±2.27天(P0.01,有显著性差异),三角形憩室的术后经期平均为8.17±1.94天(0.01P0.05,有统计学差异),细线状憩室的术后经期平均为10.5±3.54天(P0.05,无统计学差异)。有64.7%的患者在术后阴道超声结果中提示憩室完全消失,22.2%的患者在MRI结果中提示憩室完全消失,而MRI提示憩室消失的患者均同时满足在阴道超声结果中提示憩室消失的条件。10例有生育要求的患者中,1例于2016年诊断为先兆流产,未行保胎,已放弃妊娠,2例于2016年成功再次剖产,当时孕周均为37-38周左右,未见明显并发症,1例现妊娠4月余,孕检正常。[结论]1、子宫MRI是诊断剖宫产后子宫切口瘢痕憩室的有效手段,比阴道超声能更准确地对子宫憩室进行评估。2、宫腹腔镜联合修补术是治疗剖宫产后子宫切口瘢痕憩室的一种安全、可靠、微创、经济的有效手段;3、剖宫产数、憩室大小、憩室形态与剖宫产后子宫切口瘢痕憩室症状严重程度无明显相关性,但与PCSD手术疗效相关。
[Abstract]:[objective] the scar diverticulum of uterine incision after cesarean section is one of the common complications after cesarean section. There is no uniform standard for the diagnosis and treatment of scar diverticulum. The purpose of this study was to investigate the clinical effect of laparoscopy combined with repair for scar diverticulum of uterine incision after cesarean section. [methods] 58 cases of uterine scar diverticulum after cesarean section were analyzed retrospectively from 2013 to 2016 in the second affiliated Hospital of Zhejiang University. The results of 30 cases were analyzed retrospectively. [results] all patients underwent uterine MRI examination before operation, the coincidence rate with hysteroscopy was 100%. The effective rate of hysteroscopy combined with laparoscopic repair was 96.7% (29 / 30) and 80% (24 / 30) respectively. 6 months after operation, the examination of vaginal ultrasound or uterine magnetic resonance showed that the scar of uterine incision was smaller or the myometrium thicker than that of anterior (P0.01, there was significant difference). The mean postoperative menstrual period was 7.93 卤2.20 days (P 0.01, with significant difference). There were 14 cases (46.7%) with one dissection, the mean postoperative menstrual period was 7.07 卤0.99 days (P 0.01, with significant difference), 16 cases (53.3%) with 2 dissection, the mean postoperative menstrual period was 8.69 卤2.68 days (P 0.01). There is a significant difference. The mean postoperative menstrual period of cystic diverticulum was 7.2 卤2.27 days (P 0.01, with significant difference), and that of triangle diverticulum was 8.17 卤1.94 days (0.01 P 0.05, P < 0.05). The mean postoperative menstrual period of thin linear diverticulum was 10.5 卤3.54 days (P 0.05, no significant difference). 64.7% of the patients showed that the diverticulum disappeared completely, and 22.2% of the patients showed that the diverticulum disappeared completely in the results of MRI. MRI showed that the disappearing diverticulum all satisfied the condition of disappearing diverticulum in the result of vagina sonography. Of the 10 patients with fertility requirement, 1 patient was diagnosed as threatened abortion in 2016. Two cases were successfully dissected in 2016, at that time, the gestational weeks were about 37-38 weeks, no obvious complications were found, and one case was pregnant for more than 4 months, and the pregnancy test was normal. [conclusion] 1. Uterine MRI is an effective method for the diagnosis of scar diverticulum in uterine incision after cesarean section. Hysteroscopy combined repair is a safe, reliable, minimally invasive and economical method for the treatment of scar diverticulum of uterine incision after cesarean section. 3. The number of cesarean section, the size of diverticulum and the shape of diverticulum were not significantly correlated with the severity of scar diverticulum symptom of uterine incision after cesarean section, but were related to the effect of PCSD operation.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R713.4

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