改良式宫腹腔镜联合手术在剖宫产切口憩室修补中的疗效观察

目的:探讨改良式宫腹腔镜联合手术在剖宫产切口憩室修补中的疗效。方法:首都医科大学附属北京妇产医院妇科微创中心于2017年10月—2018年10月期间对经超声联合宫腔镜检查明确诊断为剖宫产子宫切口憩室且憩室底部浆肌层厚度≤2mm的21例有再生育要求患者实施改良式宫腹腔镜联合憩室修补术,随访其术后月经恢复及憩室肌层厚度改善情况。结果:全部患者手术顺利,无手术并发症、中转开腹及输血。21例患者月经复潮后门诊随访6~14个月,术后经期较术前明显缩短(6.0±1.2)dvs.(11.2±3.5)d,t=10.79,P=0.00],术后3个月行经阴道超声测量子宫下段憩室肌层厚度较术前明显增厚(3.25±0.95)mmvs.(1.59±0.30)mm,t=8.00,P=0.00]。结论:改良式宫腹腔镜联合手术通过透光定位、配合使用举宫器及宫颈管扩宫棒能够准确定位憩室并充分去除瘢痕,良好对合缝合切口,恢复子宫下段解剖结构,安全有效,值得临床推广应用。

The Effect of Modified Laparoscopic Combined Hysteroscopic Surgery on Cesarean Section Incision

Objective: To investigate the effect of modified laparoscopic combined hysteroscopic surgery on cesarean section incision diverticulum repair. Methods: From October 2017 to October 2018, 21 patients with re-fertility requirements who were confirm the diagnosis of uterine incision diverticulum in the cesarean section, and the muscle layer thickness ≤2 mm at the bottom of the diverticulum using ultrasound combined with hysteroscopy received modified laparoscopic combined with hysteroscopic surgery in department of gynecological minimally invasive center，Beijing Obstetrics and Gynecology Hospital，Capital Medical University. Follow-up of menstrual recovery and improvement of diverticulum muscle thickness was recorded. Results: All patients underwent surgery without complications. There was no conversion to open surgery or blood transfusion. 21 patients were followed up for 6 to 14 months after menstrual rehydration. The menstrual period was shortened significantly after operation (6.0±1.2) d vs. (11.2±3.5) d，t=10.79，P=0.00] . The thickness of the lower uterine segment measured by transvaginal ultrasound was increased significantly after operation (3.25±0.95) mm vs. (1.59±0.30) mm, t=8.00, P=0.00]. Conclusions: The modified laparoscopic combined hysteroscopic operation can accurately locate the diverticulum and fully remove the scar through the light-transmitting positioning, the suture incision is good and the anatomy of the lower uterus is restored. It is safe and effective, and worthy of clinical application.