经阴道剖宫产瘢痕憩室修补术的临床观察
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摘要
目的:探讨经阴道修补剖宫产瘢痕憩室的安全性及治疗效果。方法:选取2014年1月1日—2016年6月1日本院妇产科收治的经阴道行剖宫产瘢痕憩室修补术的患者临床资料并随访。结果:共26例患者纳入研究。手术时间为(60.0±20.3)min,术中出血量(50.0±25.1)ml,术后住院时间为(6.0±3.4)d,1例术中发生膀胱损伤。24/26的患者月经异常症状明显改善。修补术后经期较术前明显缩短(P=0.000),憩室的平均直径和最大直径较术前明显缩小(P=0.000)。17/26的患者术后6个月憩室完全消失。结论:经阴道修补剖宫产瘢痕憩室是有效的治疗手段,术前需全面评估患者情况,尽量避免副损伤和围手术期并发症。
Objective: To investigate the effectiveness and safty of transvaginal repair surgical for treating patients with cesarean section scar diverticulum. Methods: 26 patients with cesarean section scar diverticulum who underwent transvaginal repair from January 1, 2014 to June 1, 2016 were included, and were followed up for 6 months. The clinical data of all patients were collected. Results: The mean operation time of all included women was(60.0±20.3) minutes, the mean volume of blood loss was(50.0±25.1)ml, and time of postoperative hospital stay was(6.0±3.4)d. One case had bladder injury during operation, and 92.3%(24/26) patients had reported the improvement of prolonged period of menstruation or mid-cycle spotting. After operation, the mean duration of menstruation of all patients was significantly shortened(P=0.000), and the average diameter and maximum diameter of diverticula of patients was significantly shortened(P=0.000). The diverticula of 65.4 %( 17/26) patients had complete disappeared at 6 months after operation. Conclusion: Transvaginal repair surgical for treating patients with cesarean section scar diverticulum has better effectiveness, but patients should be carefully evaluated before operation to avoid secondary injury and perioperative complications.
Objective: To investigate the effectiveness and safty of transvaginal repair surgical for treating patients with cesarean section scar diverticulum. Methods: 26 patients with cesarean section scar diverticulum who underwent transvaginal repair from January 1, 2014 to June 1, 2016 were included, and were followed up for 6 months. The clinical data of all patients were collected. Results: The mean operation time of all included women was(60.0±20.3) minutes, the mean volume of blood loss was(50.0±25.1)ml, and time of postoperative hospital stay was(6.0±3.4)d. One case had bladder injury during operation, and 92.3%(24/26) patients had reported the improvement of prolonged period of menstruation or mid-cycle spotting. After operation, the mean duration of menstruation of all patients was significantly shortened(P=0.000), and the average diameter and maximum diameter of diverticula of patients was significantly shortened(P=0.000). The diverticula of 65.4 %( 17/26) patients had complete disappeared at 6 months after operation. Conclusion: Transvaginal repair surgical for treating patients with cesarean section scar diverticulum has better effectiveness, but patients should be carefully evaluated before operation to avoid secondary injury and perioperative complications.
引文
[1] 陶雯琪,刘伯宁.剖宫产后子宫憩室1例[J].中华围产医学杂志, 2004,7(4):254.
[2] 许川一.剖宫产切口愈合不良伴月经不调的超声和临床分析[J].浙江临床医学,2006,8(8):218.
[3] 徐天兰,张慧欣.子宫憩室妊娠破裂1例[J].临床军医杂志,2000, 28(1):77.
[4] 刘焕芝.子宫憩室致产后出DIC1例[J].中华误诊学杂志,1999, 3(16):2480.
[5] 邢小於,姜海泓,康晓梅,等. 剖宫产术后子宫憩室的临床探讨[J].医学信息,2010,23(8):3043.
[6] Thurmond A, Harvey W, Smith S. Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography[J]. Ultrasound Med,1999,18(1):13-16.
[7] Yazicioglu H, Sevket O, Ekin M, et al. Incomplete healing of the uterine incision after cesarean section: is it preventable by intraoperative digital dilatation of the internal cervical ostium?[J].Gynecol Obstet Invest, 2012,74(2):131-135.
[8] Wang CB, Chiu WW, Lee CY, et al. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position[J]. Ultrasound ObstetGynecol, 2009,34(1):85-89.
[9] Tahara M, Shimizu T, Shimoura H. Preliminary report of treatment with oral contraceptive pills for inter menstrual vaginal bleeding secondary to a cesarean section scar[J]. FertilSteril, 2016,86(2):477-479.
[10] Fiocchi F, Petrella E, Nocetti L, et al. Transvaginal ultrasound assessment of uterine scar after previous caesarean section: comparison with 3T-magnetic resonance diffusion tensor imaging[J]. Radiol Med, 2015;120(2):228-238.
[11] Pomorski M, Fuchs T, Rosner-Tenerowicz A. Standardized ultrasonographic approach for the assessment of risk factors of incomplete healing of the cesarean section scar in the uterus[J]. European Gournal of Obstet Gynecol Reprod Biol, 2016,205(10):141-145.
[12] Chang Y, Tsai EM, Long CY, et al. Resectoscopic treatment combined with sonohysterographic evaluation of women with postmenstrual bleeding as a result of previous cesarean delivery scar defects[J]. Am J Obstet Gynecol, 2009,200(4):370.1-4.
[13] Ceci O, Cantatore C, Scioscia M, et al. Ultrasonographic and hysteroscopic outcomes of uterine scar healing after cesarean section: comparison of two types of single-layer suture[J]. J ObstetGynaecol Res,2012,38(11): 1302-1307.
[14] Schepker N, Garcia-Rocha GL, von Versen-Hoynck F, et al. Clinical diagnosis and therapy of uterine scar defects after caesarean section in non-pregnant women[J]. Arch GynecolObstet,2015,291(6):1417-1423.
[2] 许川一.剖宫产切口愈合不良伴月经不调的超声和临床分析[J].浙江临床医学,2006,8(8):218.
[3] 徐天兰,张慧欣.子宫憩室妊娠破裂1例[J].临床军医杂志,2000, 28(1):77.
[4] 刘焕芝.子宫憩室致产后出DIC1例[J].中华误诊学杂志,1999, 3(16):2480.
[5] 邢小於,姜海泓,康晓梅,等. 剖宫产术后子宫憩室的临床探讨[J].医学信息,2010,23(8):3043.
[6] Thurmond A, Harvey W, Smith S. Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography[J]. Ultrasound Med,1999,18(1):13-16.
[7] Yazicioglu H, Sevket O, Ekin M, et al. Incomplete healing of the uterine incision after cesarean section: is it preventable by intraoperative digital dilatation of the internal cervical ostium?[J].Gynecol Obstet Invest, 2012,74(2):131-135.
[8] Wang CB, Chiu WW, Lee CY, et al. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position[J]. Ultrasound ObstetGynecol, 2009,34(1):85-89.
[9] Tahara M, Shimizu T, Shimoura H. Preliminary report of treatment with oral contraceptive pills for inter menstrual vaginal bleeding secondary to a cesarean section scar[J]. FertilSteril, 2016,86(2):477-479.
[10] Fiocchi F, Petrella E, Nocetti L, et al. Transvaginal ultrasound assessment of uterine scar after previous caesarean section: comparison with 3T-magnetic resonance diffusion tensor imaging[J]. Radiol Med, 2015;120(2):228-238.
[11] Pomorski M, Fuchs T, Rosner-Tenerowicz A. Standardized ultrasonographic approach for the assessment of risk factors of incomplete healing of the cesarean section scar in the uterus[J]. European Gournal of Obstet Gynecol Reprod Biol, 2016,205(10):141-145.
[12] Chang Y, Tsai EM, Long CY, et al. Resectoscopic treatment combined with sonohysterographic evaluation of women with postmenstrual bleeding as a result of previous cesarean delivery scar defects[J]. Am J Obstet Gynecol, 2009,200(4):370.1-4.
[13] Ceci O, Cantatore C, Scioscia M, et al. Ultrasonographic and hysteroscopic outcomes of uterine scar healing after cesarean section: comparison of two types of single-layer suture[J]. J ObstetGynaecol Res,2012,38(11): 1302-1307.
[14] Schepker N, Garcia-Rocha GL, von Versen-Hoynck F, et al. Clinical diagnosis and therapy of uterine scar defects after caesarean section in non-pregnant women[J]. Arch GynecolObstet,2015,291(6):1417-1423.