宮腹腔鏡下瘢痕切除修補術(shù)與媽富隆治療剖宮產(chǎn)切口憩室效果比較

陳曉琦+洛若愚+皮潔+賈勝楠

【摘要】目的：比較宮腹腔鏡下瘢痕切除修補術(shù)與媽富隆在剖宮產(chǎn)切口憩室中的治療效果，探討手術(shù)的臨床價值。方法：收集2010年2月至2014年1月在我院就診的剖宮產(chǎn)切口憩室患者98例，分別采用宮腹腔鏡下剖宮產(chǎn)切口瘢痕切除修補術(shù)（觀察組）和媽富隆周期治療（對照組），分析比較兩組患者治療效果。結(jié)果：觀察組術(shù)后陰道出血持續(xù)時間為（9.65 ± 1.72）d，月經(jīng)量減少至正常者占22.5%，愿意再次妊娠者占25.0%，超聲提示切口完全愈合占72.5%，明顯縮小占 20.0%，無明顯變化占7.5%。對照組治療后陰道出血持續(xù)時間為（13.74 ± 1.83）d，月經(jīng)量減少至正常者占5.2%，愿意再次妊娠者占5.2%，切口憩室無明顯變化。兩組間各項差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論：宮腹腔鏡下瘢痕切除修補術(shù)可明顯縮短陰道出血持續(xù)時間，其有效性和治療徹底性均優(yōu)于媽富隆周期治療，值得臨床推廣應(yīng)用。

【關(guān)鍵詞】剖宮產(chǎn)切口憩室；宮腹腔鏡聯(lián)合手術(shù)；媽富隆

Efficacy of two different treatments of cesarean section scar diverticulum： scar excision and repair by laparoscopy combined hysteroscopy and marvelon cycle therapyCHEN Xiaoqi， LUO Ruoyu△， PI Jie， JIA Shengnan. Department of Gynecology I， Renmin Hospital of Wuhan University， Wuhan 430060， Hubei， China

【Abstract】Objectives： To compared the clinical value of scar excision and repair by laparoscopy combined hysteroscopy with marvelon cycle therapy in the treatment of cesarean section scar diverticulum. Methods： 98 patients in our hospital between February 2010 and January 2014 were selected and divided into laparoscopy combined hysteroscopy group and marvelon cycle therapy group. The clinical efficacy was analyzed. Results： The vaginal bleeding time in the study group was （9.65 ± 1.72）d. The patients whose menstruation returned to normal accounted for 22.5%， and the rate of re-pregnancy was 25.0%. The patients whose incision completely healed accounted for 72.5%， and those with significantly reduced and no changed incision were 20.0% and 7.5% respectively. In control group， the vaginal bleeding time was （13.74 ± 1.83）d. The patients whose menstruation returned to normal accounted for 5.2%， and the rate of re-pregnancy was 5.2%. Incision defect of patients had no significant improvement. The differences between two groups were significant （P<0.05）. Conclusion： The scar excision and repair surgery can effectively reduce the vaginal bleeding time， and its effectiveness and thoroughness is significantly higher than marvelon cycle therapy， which should be widely applied.

【Key words】Cesarean section scar diverticulum； Laparoscopy combined hysteroscopy surgery； Marvelon

【中圖分類號】R714.4【文獻標(biāo)志碼】A

剖宮產(chǎn)切口憩室（cesarean section scar diverticulum， CSSD），于1995年由Morris[1]首次提出，是指子宮前壁下端在剖宮產(chǎn)切口部位向外膨出而形成囊袋狀，從而導(dǎo)致經(jīng)期延長、月經(jīng)間期陰道出血、慢性盆腔痛、不孕等，嚴(yán)重影響育齡期婦女的身心健康。隨著剖宮產(chǎn)率的攀升，CSSD的發(fā)病率高達50%，逐漸受到臨床醫(yī)生的重視。臨床上治療剖宮產(chǎn)切口憩室主要包括藥物治療和手術(shù)治療，但目前對于CSSD的治療尚缺乏規(guī)范的治療標(biāo)準(zhǔn)。本研究旨在對比剖宮產(chǎn)切口瘢痕切除修補術(shù)與媽富隆周期治療CSSD的臨床效果，探討手術(shù)治療的臨床價值，以期為臨床提供有效治療的措施。

1資料與方法

1.1研究對象endprint

收集2010年2月至2014年1月我院就診的剖宮產(chǎn)切口憩室患者98例。……