宫腹腔镜联合手术修补剖宫产术后子宫切口憩室的效果分析

目的:探讨剖宫产术后子宫切口憩室发生的可能原因及宫腹腔镜联合手术治疗的效果。方法:对2008年8月—2013年8月在江苏省启东市中医院经宫腹腔镜联合手术修补剖宫产术后子宫切口憩室的9例患者的临床资料进行回顾分析。结果:9例子宫切口憩室患者均表现为月经淋漓不净,经期7~24(15.2±3.5)d,其中1例表现为不孕,3例有经期下腹坠痛。术前子宫输卵管造影(hysterosalpingography,HSG)检查显示,憩室宽度为15~28(20.2±4.0)mm,深度为6~20(12.3±3.6)mm。患者剖宫产手术指征为瘢痕子宫(3例)、胎膜早破(2例)、难产(1例)和胎儿窘迫(3例)。5例剖宫产术中切口缝合1层,4例缝合2层。9例患者均行宫腹腔镜联合手术修补子宫切口憩室,无中转开腹手术,术中术后均未出现并发症,无输血。9例均月经复潮且症状得到改善,经期缩短为6~9(7.5±2.0)d。结论:宫腹腔镜联合手术修补子宫切口憩室的治愈率高,可以显著改善患者症状。

Hysteroscopy Combined with Laparoscopy in the Repair of Uterine Incision Diverticulum after Cesarean Section

Objective：To explore the possible pathogenesis of uterine incision diverticulum after cesarean section and the effect of hysteroscopy combined with laparoscopy in surgical repair.Methods：The clinical data of 9 patients with uterine incision diverticulum after cesarean section who underwent surgical repair by hysteroscopy combined with laparoscopy in Qidong Hospital of Traditional Chinese Medicine from August 2008 to August 2013 were analyzed retrospectively.Results：All the nine patients with uterine incision diverticulum had a prolonged menstruation,and the menstrual period was 7-24（15.2±3.5）d.One case had infertility.Three cases complained of lower abdominal pain during menstruation.Preoperative hysterosalpingography（HSG）showed that the width of the diverticulum was 15-28（20.2±4.0）mm,and the depth was 6-20（12.3±3.6）mm.The indications of cesarean section were uterine scar（3 cases）,premature rupture of fetal membranes（2 cases）,dystocia（1 case）and fetal distress（3 cases）.The uterine was sutured by 1 layer of absorbable material in 5 cases and 2 layers in 4 cases during the cesarean section.Surgical repair of the uterine incision diverticulum by hysteroscopy combined with laparoscopy was performed in all 9patients.None was transferred to laparotomy.There was no intra-operative and post-operative complication.None of the patients required blood transfusion.All the 9 patients had recovery of menstruation and improvement of symptoms.The menstrul period was shortened to 6-9（7.5±2.0）d.Conclusions：Hysteroscopy combined with laparoscopy has high curative rate in the surgical repair of the uterine incision diverticulum and can significantly improve the patients＇ symptoms.