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目的探讨剖宫产术后远期子宫出血的原因及宫腔镜的临床诊断价值。方法对2005年1月至2010年2月郑州大学第二附属医院妇产科收治的剖宫产术后半年以上的异常子宫出血患者109例行超声联合宫腔镜检查。结果 109例剖宫产术后远期子宫出血行宫腔镜检查,发现59例子宫下段憩室腔积血,占54.2%,其中憩室合并息肉2例;剖宫产切口瘢痕妊娠18例(占16.5%),剖宫产切口部位息肉16例(占14.7%),子宫下段缝合线残留14例(占12.8%),子宫假性动脉瘤1例(占0.9%),剖宫产切口部位动静脉瘘1例(占0.9%)。结论子宫下段憩室腔积血是剖宫产术后远期子宫出血最常见原因;宫腔镜对剖宫产术后远期子宫出血具有明确诊断作用,部分病例宫腔镜下还可行有效治疗。
Objective To investigate the causes of distant uterine bleeding after cesarean section and the clinical value of hysteroscopy. Methods From January 2005 to February 2010, Zhengzhou University Second Affiliated Hospital of Obstetrics and Gynecology admitted to the cesarean section after more than six months of abnormal uterine bleeding in 109 patients underwent ultrasound combined with hysteroscopy. Results 109 cases of long-term uterine bleeding after cesarean section hysteroscopy and found 59 cases of uterine segment diverticular hemorrhage, accounting for 54.2%, of which diverticulum polyps in 2 cases; cesarean section scar pregnancy 18 cases (16.5% ), Cesarean section incision polyps in 16 cases (14.7%), lower uterine suture in 14 cases (12.8%), uterine pseudoaneurysm in 1 case (0.9%), cesarean section at the arteriovenous fistula 1 case (0.9%). Conclusions Hemorrhagic hemorrhage in the lower uterine segment is the most common cause of long-term uterine bleeding after cesarean section. Hysteroscopy has a definite role in diagnosis of long-term uterine bleeding after cesarean section. In some cases, hysteroscopic surgery is feasible and effective.