三种手术方式治疗剖宫产瘢痕憩室的疗效对比

目的探讨3种手术方式治疗剖宫产瘢痕憩室（CSD）的疗效。 方法选择2013年1月至2018年1月浙江大学医学院附属第一医院经阴道超声诊断为CSD的患者80例：40例行宫腔镜下憩室电切割术（宫腔镜组），30例行宫腹腔镜联合憩室修补术（宫腹腔镜联合组），10例行阴式憩室修补术（阴式组）。对3组患者的年龄、剖宫产次数、术前经期、手术时间、术中出血量、住院时间、住院费用等指标，多组比较采用方差分析，两两比较采用LSD法。对3组患者术后随访12个月的治疗有效情况和复发情况采用χ²检验，两两比较采用χ²分割法，采用BONFERRONI法进行校正。 结果宫腔镜组、宫腹腔镜联合组和阴式组3组患者年龄、剖宫产次数、术前经期比较，差异均无统计学意义（P均>0.05）。宫腔镜组手术时间、术中出血量、住院天数、住院费用均明显少于宫腹腔镜联合组、阴式组（F=198.300，P<0.001；F=19.610，P<0.001；F=29.450，P<0.001；F=342.880，P<0.001）。3组患者术后随访12个月治疗有效率和复发率比较，差异无统计学意义（P均>0.05）。 结论3种手术方式治疗CSD均具有良好的有效性，宫腔镜下憩室电切割术临床应用价值更高。

Comparison of therapeutic effects of three surgical approaches for cesarean scar diverticulum

ObjectiveTo compare the therapeutic effects of three surgical approaches for cesarean scar diverticulum (CSD). MethodsFrom January 2013 to January 2018, 80 patients diagnosed with CSD by transvaginal ultrasound at the First Affiliated Hospital of Zhejiang University were selected and divided into three groups: 40 patients who underwent hysteroscopic electrical incision of the diverticulum (hysteroscopic group), 30 patients who were treated by hysteroscopic-laparoscopic diverticulum repair (hysteroscopic-laparoscopic group), and 10 patients who underwent transvaginal repair of CSD (transvaginal group). For age, frequency of cesarean section, preoperative menstrual period, operative time, intraoperative bleeding, postoperative hospital stay, hospitalization expenses, and other indicators of the three groups, ANOVA was used for comparison among multiple groups, and LSD method was used for pairwise comparison. The efficacy and recurrence in the three groups within 12 months of follow-up were evaluated by the Chi-square test, pairwise comparison was performed by Chi-square segmentation, and they were finally corrected by the BONFERRONI method. ResultsThe operative time, intraoperative blood loss, postoperative hospital stay, and hospitalization cost of the hysteroscopic group were significantly less than those of the hysteroscopic-laparoscopic group and the transvaginal group (F=198.300, P<0.001; F=19.610, P<0.001; F=29.450, P<0.001; F=342.880, P<0.001), but there was no significant difference in age, frequency of cesarean section, or preoperative menstrual period among the three groups (P>0.05). In addition, there was no statistically significant difference in the efficacy or recurrence among the three groups within 12 months of follow-up (P>0.05). ConclusionAll the three surgical methods have good effectiveness in the treatment of CSD, and hysteroscopic electrical incision of the diverticulum has higher clinical application value.