[1]黄艳 彭超 陆叶 周应芳*.腹腔镜折叠对接缝合联合宫腔镜开渠法治疗剖宫产瘢痕憩室[J].中国微创外科杂志,2022,01(4):343-346.
　Huang Yan,Peng Chao,Lu Ye,et al.Laparoscopic “Folding Suture Method” Combined With Hysteroscopic “Canal Opening Method” for the Treatment of Cesarean Scar Diverticulum[J].Chinese Journal of Minimally Invasive Surgery,2022,01(4):343-346.
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腹腔镜折叠对接缝合联合宫腔镜开渠法治疗剖宫产瘢痕憩室()

《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2022年4期
页码:
343-346
栏目:
技术改进
出版日期:
2022-07-20

文章信息/Info

Title:
Laparoscopic “Folding Suture Method” Combined With Hysteroscopic “Canal Opening Method” for the Treatment of Cesarean Scar Diverticulum
作者:
黄艳 彭超 陆叶 周应芳*
(北京大学第一医院妇产科，北京100034)
Author(s):
Huang Yan;  Peng Chao;  Lu Ye;  et al.
Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China
关键词:
剖宫产瘢痕憩室; 宫腔镜; 腹腔镜; 妊娠结局
Keywords:
Cesarean scar diverticulum; Hysteroscopy; Laparoscopy; Pregnancy outcome
文献标志码:
A
摘要:
目的探讨腹腔镜折叠对接缝合联合宫腔镜开渠法治疗剖宫产瘢痕憩室(cesarean scar diverticulum，CSD)的疗效。方法回顾性分析2016年8月~2020年12月16例CSD的资料。宫腔镜电切憩室下极隆起处瘢痕(开渠)并电凝憩室内膜，腹腔镜折叠对接缝合憩室上下极加厚肌层。随访术后疗效及妊娠结局。结果手术时间(86.5±17.0)min，无手术并发症。术后3个月复查，经期由(12.5±6.1)d缩短到(7.1±2.7)d(配对t检验，t=4.926，P=0.000)，较术前缩短(5.2±4.2)d；子宫下段厚度由术前的(1.8±0.9)mm增加到(6.5±1.5)mm(配对t检验，t=-12.963，P=0.000)。治愈10例(经期恢复正常，超声检查子宫下段憩室消失)，好转6例(经期较术前缩短，但仍>7天，超声检查子宫下段憩室缩小或消失)。术后6个月9例开始试孕，妊娠7例，其中足月分娩4例，胎儿因素流产2例，剖宫产瘢痕妊娠1例。结论腹腔镜折叠对接缝合联合宫腔镜开渠法治疗CSD可保留子宫完整性，增加子宫下段厚度，缩短经期。
Abstract:
ObjectiveTo investigate the efficacy of laparoscopic “folding suture method” combined with hysteroscopic “canal opening method” as a surgical procedure for the treatment of cesarean scar diverticulum (CSD).MethodsClinical data of 16 patients with CSD from August 2016 to December 2020 were retrospectively analyzed. Hysteroscopic electric incision of the scar at the lower uplift of the diverticulum (canal opening) and electrocoagulation of the endometrium of the diverticulum were performed, and the upper and lower layers of the diverticulum were sutured to increase the thickness of muscle layer under laparoscope. Postoperative efficacy and pregnancy outcomes were followed up.ResultsThe surgical duration was (86.5±17.0) min. There were no surgical complications. Three months after the operation, the menstrual period was shortened from (12.5±6.1) days to (71±2.7) days (paired ttest,t=4.926，P=0.000), which was (5.2±4.2) days shorter than that before surgery. The thickness of lower uterine segment increased from (1.8±0.9) mm to (6.5±1.5) mm (paired ttest,t=-12.963，P=0.000). There were 10 cases of cure (menstrual period returned to normal and ultrasound examination of diverticulum in lower uterine segment disappeared) and 6 cases of improvement (menstrual period shorter than before but still > 7 days and the diverticulum in the lower segment of uterus was reduced or disappeared by ultrasound). Six months after operation, 9 cases tried for pregnancy and 7 of them were pregnant, including 4 cases of full term delivery, 2 cases of fetal factor abortion, and 1 case of cesarean scar pregnancy.ConclusionCSD repair with laparoscopic “folding suture method” combined with hysteroscopic “canal opening method” can preserve uterine integrity, increase the thickness of the lower uterine segment, and shorten the menstrual period.

参考文献/References:

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备注/Memo

备注/Memo:
*通讯作者，Email：zhouyf8853@163.com
更新日期/Last Update: 2022-07-21