摘要
目的:探讨宫腔镜电切术与宫腹腔镜联合肌瓣填充缝合术治疗子宫瘢痕憩室的临床疗效。方法:回顾分析2018年8月至2023年6月手术治疗的68例子宫瘢痕憩室患者的临床资料,根据手术方式分为两组,A组(n=38)行宫腔镜电切术,B组(n=30)行宫腹腔镜联合肌瓣填充缝合术。比较两组手术相关指标、临床疗效、术后3个月子宫前壁下端肌层厚度等。结果:两组术后经期均缩短,手术前后差异有统计学意义(P<0.05);A组术中出血量少于B组,手术时间、住院时间均短于B组,差异有统计学意义(P<0.05);术后3个月复查子宫前壁下端肌层厚度,A组手术前后差异无统计学意义,B组由术前的(2.09±0.48)mm增加至术后的(6.52±0.21)mm,差异有统计学意义(P<0.05)。结论:两种术式均能明显改善剖宫产术后子宫瘢痕憩室引起的异常子宫出血症状。宫腔镜电切术操作相对简单、创伤小、术中出血少、手术时间短,适于无生育要求、月经期延长影响生活质量、术前子宫憩室残存子宫肌层厚度≥3 mm的患者;宫腹腔镜联合肌瓣填充术不破坏子宫的完整性,术后避孕时间短,可增加术后子宫前壁肌层厚度,适于有生育要求的子宫憩室患者。
Objective:To investigate the clinical effectiveness of hysteroscopic electrotomy and hysteroscopic combined with laparoscopic muscle flap filling suture in the treatment of uterine scar diverticulum.Methods:Retrospective analysis was made on the clinical data of 68 patients with uterine scar diverticulum who underwent surgical treatment from Aug.2018 to Jun.2023.They were divided into 2 groups according to the surgical method.Group A(n=38)underwent hysteroscopic electrotomy,group B(n=30)under-went hysteroscopic combined with laparoscopic muscle flap filling suture.The surgical parameters,clinical efficacy,and anterior uterine wall thickness 3 months after operation were compared between the two groups.Results:The menstrual period of two groups significantly shortened,and were statistically significant before and after surgery(P<0.05);intraoperative blood loss,operation time and hospital stay of group A were less than those of group B(P<0.05).Three months after surgery,there was no significant change in muscle layer thickness at front wall of uterine lower extreme before and after surgery in group A.After surgery the thickness of the uterine muscle layer in group B significantly increased from(2.09±0.48)mm to(6.52±0.21)mm(P<0.05).Conclusions:Both the hysteroscopic electrotomy and hysteroscopic combined with laparoscopic muscle flap filling suture can significantly improve the abnormal uterine bleeding symptoms caused by uterine scar diverticulum after cesarean section.Hysteroscopic electrotomy is relatively simple,with few trauma and intraoperative blood loss,and short operation time.This method is suitable for patients with no fertility intention,prolonged menstrual periods affecting the quality of life,and residual uterine muscle layer thickness at diverticulum≥3 mm.Hysteroscopic combined with laparoscopic muscle flap filling suture does not destroy the integrity of the uterus.The postoperative contraceptive time is short.It can increase the muscle layer thickness of uterine front wall,is the preferred surgery for uterine diverticulum patients with fertility requirements.
作者
李开芹
林立波
邵晓彤
娄琰琰
许宗兰
田永会
曹佃霞
LI Kaiqin;LIN Libo;SHAO Xiaotong(Department of Gynecology,Linyi Central Hospital,Linyi 276400,China)
出处
《腹腔镜外科杂志》
2024年第6期462-465,470,共5页
Journal of Laparoscopic Surgery
关键词
子宫瘢痕憩室
电切术
肌瓣填充术
宫腔镜检查
腹腔镜检查
疗效比较研究
Cervical scar diverticulum
Electrocautery
Myometrial flap filling
Hysteroscopy
Laparoscopy
Comparative effec-tiveness research
