中国循证医学杂志

中国循证医学杂志

不同术式治疗剖宫产切口憩室的疗效和安全性

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目的 探讨临床常用治疗剖宫产切口憩室不同术式的疗效和安全性。 方法 采用回顾性研究方法,搜集 2012 年 7 月~2016 年 12 月在四川大学华西第二医院妇科诊断剖宫产切口憩室且行手术治疗住院患者的临床资料,并对患者进行随访。采用 SPSS 22.0 软件分析不同术式患者的围术期数据、术后缓解、复查情况等。 结果 共纳入 125 例患者,其中采用宫腔镜电切憩室活瓣组织并电凝憩室创面(电切活瓣组)的患者 74 例,其它术式切除憩室并切口缝合修补(切除憩室组)的患者 51 例。统计分析结果显示电切活瓣组在术中出血量、手术时间、肛门排气时间和住院时间等方面均优于切除憩室组,其差异均有统计学意义(P<0.001)。按不同术式进行两两比较,结果显示宫腔镜手术在术中出血量、手术时间、肛门排气时间和住院时间等方面均最优,而开腹手术最差。 结论 本研究结果显示宫腔镜电切憩室活瓣组织并电凝憩室创面是目前使用最多的术式,其具有直视、微创、简便、术后恢复快、并发症发生率低等优势,可能为治疗剖宫产切口憩室最佳选择术式。

Objective To analyze the efficacy and safety of different operation methods in patients with cesarean scar diverticulum. Methods The clinical data of patients with cesarean section scar diverticulum treated in West China Second University Hospital from July 2012 to December 2016 was collected and followed up. The data of the previous perioperative period data, recovery, the improvement of the symptoms and postoperative condition of incision healing were analyzed by using SPSS 22.0 software. Results A total of 125 patients were included, in which 74 cases receiving hysteroscopy surgery for diverticulum electro section and electric coagulation (ESEC group), and 51 cases having other surgery focused on diverticulum dissection and sewing operations (DS group). The results of statistical analysis showed that, compared with DS group, bleeding, operation time, time of anal exsuffiation and hospitalization duration after the operation of hysteroscopy in ESEC group were significantly reduced (P<0.001). In addition, the results showed that hysteroscopy group had optimal results in hemorrhage volume, operation time, anal exhaust time and hospitalization time indicators. While the results of laparotomy group was not obvious. Conclusion For the treatment of CSD, surgical treatment of this pathology by operative hysteroscopy may represent the best choice in symptomatic women because of its minimal invasiveness and beneficial therapeutic results. Hysteroscopy isthmoplasty appears to be the most popular treatment.

关键词: 剖宫产; 切口憩室; 宫腔镜; 开腹手术; 宫腹腔镜联合; 腹腔镜; 阴式手术

Key words: Cesarean section; Cesarean section diverticulum; Hysteroscopy; Laparotomy; Hysteroscopy combined with laparoscopy; Laparoscopy; Vaginal surgery

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