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[1]王丽芳,李晓雨,赵艳忠,等.两种不同手术方式治疗剖宫产切口憩室的疗效分析[J].医学研究与战创伤救治(原医学研究生学报),2023,25(1):39-42.[doi:10.3969/j.issn.1672-271X.2023.01.008]
　WANG Lifang,LI Xiaoyu,ZHAO Yanzhong,et al.Clinical efficacy of two different surgical methods in treatment of previous cesarean scar defect[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2023,25(1):39-42.[doi:10.3969/j.issn.1672-271X.2023.01.008]
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两种不同手术方式治疗剖宫产切口憩室的疗效分析()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第25卷
期数:
2023年1期
页码:
39-42
栏目:
临床研究
出版日期:
2023-05-10

文章信息/Info

Title:
Clinical efficacy of two different surgical methods in treatment of previous cesarean scar defect
作者:
王丽芳; 李晓雨; 赵艳忠; 刘玉环
作者单位：100038北京，首都医科大学附属复兴医院妇产科（王丽芳、李晓雨、赵艳忠、刘玉环）
Author(s):
WANG Lifang;  LI Xiaoyu;  ZHAO Yanzhong;  LIU Yuhuan
（Department of Obstetrics and Gynecology，Fu Xing Hospital，Capital Medical University，Beijing 100038，China）
关键词:
剖宫产切口憩室; 宫腔镜检查联合经阴道剖宫产切口憩室修补术; 宫腔镜; 疗效; 残余肌层厚度; 妊娠
Keywords:
previous cesarean scar defect; hysteroscopy-assisted transvaginal repair of scar defect; hysteroscopy;  efficacy;  residual muscularis thickness;  gestation
分类号:
R713.4
DOI:
10.3969/j.issn.1672-271X.2023.01.008
文献标志码:
A
摘要:
目的探讨宫腔镜剖宫产切口憩室修整术和宫腔镜检查联合经阴道剖宫产切口憩室修补术两种手术方式治疗剖宫产切口憩室(PCSD)的临床疗效，寻找最佳手术方式，指导临床治疗。方法回顾性分析2017年1月至2022年2月首都医科大学附属复兴医院收治的70例PCSD 患者的临床资料,根据手术方式分为2组,A 组为宫腔镜检查联合经阴道行剖宫产切口憩室修补术，共33例；B组为宫腔镜剖宫产切口憩室修整术，共37例。比较2组患者手术时间、术中出血量、术后阴道出血时间、住院时间、总费用、术后月经改善情况、剖宫产切口憩室恢复情况及妊娠率。结果A组与B组手术时间[(95.91±4.54)minvs(80.0±10.20)min, P<0.01)min]、术中出血量[(40.91±2.66）mLvs(5.14±0.01）mL, P<0.01]、术后阴道出血时间[(7.56±1.64）dvs(9.47±1.83）d, P<0.05]、住院天数[ (5.45±0.23）dvs(2.86±0.29）d, P<0.01]、总费用[(1.07±0.23）万元vs(0.68±0.12）万元, P<0.01]、术前残余肌层厚度[(2.35±0.179）mmvs(3.31±0.33）mm, P<0.01]、术后残余肌层厚度[(6.02±0.13）mmvs(2.83±0.46）mm, P<0.01]相比较差异均有统计学意义，A 组与B组妊娠率差异无统计学意义(50%vs45%，P> 0.05)。结论两种手术方式临床上各有优势,因此应根据患者具体情况及要求,选择最佳手术方式。
Abstract:
ObjectiveTo compare the clinical efficacy between hysteroscopy-assisted transvaginal repair of scar defect and hysteroscopic cesarean scar defect repair in the treatment of patients with previous cesarean scar defect.MethodsClinical data of 70 patients with previous cesarean scar defect who received surgical treatments in the Fuxing Hospital affiliated to Capital Medical University from January 2017 to February 2022 were collected and they were divided into two groups according to the operation mode. Group A consisted of 33 patients who underwent hysteroscopy-assisted transvaginal repair of scar defect. In group B, 37 cases were treated with hysteroscopic cesarean scar defectrepair. The surgical conditions, surgical efficacy and following-up the pregnant outcome were analyzed.ResultsThe operation time [(95.91±4.54)min vs(80.0±10.20)min, P<0.01)min], intraoperative bleeding volume [(40.91±2.66）mLvs(5.14±0.01）mL, P<0.01], postoperative vaginal bleeding time [(7.56±1.64）dvs(9.47±1.83）d, P<0.05], hospitalization days [ (5.45±0.23）dvs(2.86±0.29）d, P<0.01], total cost [(1.07±0.23）million vs(0.68±0.12）million, P<0.01], preoperative residual muscle thickness [(2.35±0.179）mm vs(3.31±0.33）mm, P<0.01] in group A and group B were significantly different. The thickness of residual muscle layer after operation [(6.02±0.13）mmvs(2.83±0.46）mm, P<0.01] was significantly different (P<0.05), but the difference in pregnancy rate between group A and group B was not statistically significant (50% vs 45%, P>0.05).ConclusionThe two surgical methods have their own clinical advantages, so the best surgical method should be selected according to the specific conditions and requirements of patients.

参考文献/References:

[1]Chueh HY, Pai AH, Su YY, et al.Hysteroscopic removal, with or without laparoscopic assistance, of first-trimester cesarean scar pregnancy[J]. Fertil Steril，2022，117(3): 643-645.
[2]Saccone G, De Angelis MC, Zizolfi B, et al. Monofilament vs multifilament suture for uterine closure at the time of cesarean delivery: a randomized clinical trial[J]. Am J Obstet Gynecol MFM，2022，4(3):100592.
[3]Xiang J, Cao Y, Zhou L,et al.Evaluation of the necessity of laparoscopic repair of a uterine scar defect for cesarean scar pregnancy[J]. Int Med Res，2022，50(1): 3000605211070753.
[4]Karampelas S, Salem Wehbe G, de Landsheere L,et al.Laparoscopic Isthmocele Repair: Efficacy and Benefits before and after Subsequent Cesarean Section[J]. J Clin Med，2021，10(24): 5785.
[5]Zhang NN, Wang GW, Zuo N,et al.Novel laparoscopic surgery for the repair of cesarean scar defect without processing scar resection[J]. BMC Pregnancy Childb，2021，21(1): 815.
[6]Hur C, Luna-Russo M, King C, Fertility-Preserving Surgical Management of a Cesarean Section Scar Ectopic Pregnancy[J]. J Minim Invasive Gynecol，2022，29(2): 194.
[7]Stupak A, Kondracka A, Fronczek A,et al.Scar Tissue after a Cesarean Section-The Management of Different Complications in Pregnant Women[J].Environ Res Public Health， 2021，18(22):11998.
[8]Mancuso AC, Maetzold E, Kowalski J,et al.Surgical repair of a cesarean scar defect using a vaginal approach[J]. Fertil Steril，2021，116(2): 597-598.
[9]Zhang Q, Lei L, Zhang A,et al.Comparative effectiveness of laparoscopic versus hysteroscopic approach in patients with previous cesarean scar defect: a retrospective cohort study[J].Ann Transl Med，2021，9(20): 1529.
[10]Glenn TL, Han E. Cesarean scar defect: far from understood[J].Fertil Steril，2021，116(2): 369-370.
[11]Wang HF, Chen HH, Ting WH,et al.Robotic or laparoscopic treatment of cesarean scar defects or cesarean scar pregnancies with a uterine sound guidance[J].Obstet Gynecol，2021，60(5): 821-826.
[12]Siraj SHM, Lional KM, Tan KH, Repair of the myometrial scar defect at repeat caesarean section: a modified surgical technique[J].BMC Pregnancy Childb，2021，21(1): 559.
[13]罗娟,韩克,汤晓秋,等.不同术式治疗早孕期剖宫产术后子宫瘢痕妊娠各分型的效果分析[J].东南国防医药,2018,20(6):586-591.
[14]Ou YC, Chen YY, Lan KC, et al.Levonorgestrel intrauterine system for the treatment of intermenstrual spotting in patients with previous cesarean delivery scar defect[J].Obstet Gynaecol Res，2022，48(1): 155-160.
[15]Dai L, Wang H, Xing X,et al.An analysis of curative effect of combined transvaginal and hysteroscopic electrocauterization of partial endometrium to treat previous cesarean scar diverticulum[J]. Minerva Surg，2022，77(2):139-146.
[16]中华医学会计划生育学分会.剖宫产术后子宫瘢痕憩室诊治专家共识[J]. 中华妇产科杂志，2019，54(3): 145-148.
[17]Cao S, Qiu G, Zhang P,et al.A Comparison of Transvaginal Removal and Repair of Uterine Defect for Type II Cesarean Scar Pregnancy and Uterine Artery Embolization Combined With Curettage[J]. Front Med (Lausanne)，2021，8:654956.
[18]Cok T. Regarding "Obstetric and Gynecologic Outcomes after the Transvaginal Repair of Cesarean Scar Defect in a Series of 183 Women"[J]. J Minim Invasive Gynecol，2021，28(8):1552.
[19]Al Mutairi BH, Alrumaih I. Hysteroscopy in the Treatment of Myometrial Scar Defect (Diverticulum) Following Cesarean Section Delivery: A Systematic Review and Meta-Analysis[J].Cureus，2020，12(11): e11317.
[20]Tsuji S, Takahashi A, Higuchi A,et al.Pregnancy outcomes after hysteroscopic surgery in women with cesarean scar syndrome[J].PLoS One，2020，15(12): e0243421.
[21]Zeller A, Villette C, Fernandez H, et al.Is Hysteroscopy a Good Option to Manage Severe Cesarean Scar Defect[J].J Minim Invasive Gynecol，2021，28(7): 1397-1402.
[22]Dosedla E, Gál P, Calda P. Association between deficient cesarean delivery scar and cesarean scar syndrome[J].Clin Ultrasound，2020，48(9): 538-543.
[23]Dou Y, Zeng D, Zou Z,et al.Hysteroscopic treatment of cesarean scar defect[J].Arch Gynecol Obstet，2020，302(5): 1215-1220.

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更新日期/Last Update: 2023-04-19