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目的比较宫腔镜联合腹腔镜引导下修补术与阴式修补术治疗剖宫产术后子宫切口憩室(PCSD)的疗效和预后。方法采用回顾性分析方法,收集2011年1月至2013年12月收治的70例符合纳入标准的PCSD患者,按手术方式分为宫腔镜联合腹腔镜引导下修补术组(腔镜组,n=35)和阴式修补术组(阴式组,n=35)。比较两组患者术中和术后情况,治疗后憩室和经期改善情况以及随访预后情况。结果所有患者均手术成功,无手术相关并发症发生。与阴式组相比,腔镜组术中出血量明显减少(P<0.01),术后阴道出血时间及住院时间明显缩短(P均<0.01),而手术时间明显延长(P<0.01),术后肛门排气时间两组无明显差异(P>0.05)。治疗后与治疗前比较,两组患者憩室深度和宽度均明显减小(P均<0.05),经期均明显缩短(P均<0.05),而组间比较无统计学差异(P均>0.05)。随访6个月,腔镜组的有效率、复发率和再孕率分别为94.3%、2.9%和20.0%,阴式组分别为91.4%、8.6%和14.3%,组间比较均无统计学差异(P均>0.05)。结论宫腔镜联合腹腔镜引导下修补术与阴式修补术都是治疗PCSD的有效手术方法,可以显著改善患者症状,两者各有优势,可根据具体情况选择合适的手术方法以达到最佳效果。
Objective To compare the efficacy and prognosis of hysteroscopic laparoscopic-guided repair and vaginal repair for cesarean section incision diverticulum (PCSD). Methods A retrospective analysis was performed in 70 PCSD patients who met the inclusion criteria from January 2011 to December 2013. The patients underwent hysteroscopy combined with laparoscopic-guided repair (endoscopic group, n = 35) and vaginal repair group (vaginal group, n = 35). The postoperative and postoperative outcomes were compared between the two groups. The improvement of diverticulum and menstruation after treatment and prognosis of follow-up were compared. Results All the patients were operated successfully without any operative complications. Compared with the vaginal group, the amount of bleeding in the endoscopic group was significantly decreased (P <0.01), the postoperative vaginal bleeding time and hospitalization time were significantly shorter (P <0.01), while the operation time was significantly longer (P <0.01) Postoperative anal exhaust time was no significant difference between the two groups (P> 0.05). After treatment, the depth and width of diverticulum in both groups were significantly reduced (all P <0.05), and the menstrual period were significantly shorter (all P <0.05), but there was no significant difference between the two groups (all P> 0.05) . The follow-up of 6 months showed that the effective rate, recurrence rate, and pregnancy rate were 94.3%, 2.9% and 20.0% in the endoscopic group and 91.4%, 8.6% and 14.3% in the vaginal group, respectively Difference (all P> 0.05). Conclusion Hysteroscopy combined with laparoscopic repair and vaginal repair are effective surgical treatment of PCSD can significantly improve the symptoms of patients, both have their own advantages, according to the specific circumstances select the appropriate surgical methods to achieve the best effect.