国际妇产科学杂志

国际妇产科学杂志 ›› 2019, Vol. 46 ›› Issue (4): 430-433.

• 论著 • 上一篇    下一篇

改良式宫腹腔镜联合手术在剖宫产切口憩室修补中的疗效观察

陈芳，王欣，张佟，叶红   

  1. 100006 北京，首都医科大学附属北京妇产医院妇科微创中心
  • 收稿日期:2019-03-21 修回日期:2019-04-25 出版日期:2019-08-15 发布日期:2019-08-15
  • 通讯作者: 叶红，E-mail：yehong8812@sina.com E-mail:yehong8812@sina.com
  • 作者简介:2019-07-31
  • 基金资助:
    首都卫生发展科研专项项目（2016-4-2115）；首都医科大学附属北京妇产医院中青年学科骨干培养专项（fcyy201533）

The Effect of Modified Laparoscopic Combined Hysteroscopic Surgery on Cesarean Section Incision

CHEN Fang，WANG Xin，ZHANG Tong，YE Hong   

  1. Department of Gynecological Minimally Invasive Center，Beijing Obstetrics and Gynecology Hospital，Capital Medical University，Beijing 100006，China
  • Received:2019-03-21 Revised:2019-04-25 Published:2019-08-15 Online:2019-08-15
  • Contact: YE Hong，E-mail：yehong8812@sina.com E-mail:yehong8812@sina.com

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摘要： 【摘要】目的：探讨改良式宫腹腔镜联合手术在剖宫产切口憩室修补中的疗效。方法：我们于2017年10月～2018年10月期间，对经超声联合宫腔镜检查明确诊断为剖宫产子宫切口憩室，且憩室底部浆肌层厚度≤2mm的21例有再生育要求患者，实施改良式宫腹腔镜联合憩室修补，随访其术后月经恢复及憩室肌层厚度改善情况。结果：全部患者手术顺利，无并发症、无中转开腹及输血病例。21例患者月经复潮后门诊随访6～14个月，经期由的术前11.2±3.5天缩短至术后的6.0±1.2天，术后3月行经阴道超声测量子宫下段厚度由术前的1.59±0.30mm增厚至术后的3.25±0.95mm，差异均显著（P＜0.01）。结论：改良式宫腹腔镜联合手术通过透光定位、配合使用举宫器及宫颈扩棒能够准确定位憩室并充分去除瘢痕，良好对合缝合切口，恢复子宫下段解剖结构，安全有效，值得临床推广应用。

关键词: 剖宫产术, 子宫, 憩室, 宫腔镜检查, 腹腔镜检查

Abstract: Objective: To investigate the effect of modified laparoscopic combined hysteroscopic surgery on cesarean section incision diverticulum repair. Methods: From October 2017 to October 2018, 21 patients with re-fertility requirements who were confirm the diagnosis of uterine incision diverticulum in the cesarean section, and the muscle layer thickness ≤2 mm at the bottom of the diverticulum using ultrasound combined with hysteroscopy received modified laparoscopic combined with hysteroscopic surgery in department of gynecological minimally invasive center，Beijing Obstetrics and Gynecology Hospital，Capital Medical University. Follow-up of menstrual recovery and improvement of diverticulum muscle thickness was recorded. Results: All patients underwent surgery without complications. There was no conversion to open surgery or blood transfusion. 21 patients were followed up for 6 to 14 months after menstrual rehydration. The menstrual period was shortened significantly after operation [(6.0±1.2) d vs. (11.2±3.5) d，t=10.79，P=0.00] . The thickness of the lower uterine segment measured by transvaginal ultrasound was increased significantly after operation [(3.25±0.95) mm vs. (1.59±0.30) mm, t=8.00, P=0.00]. Conclusions: The modified laparoscopic combined hysteroscopic operation can accurately locate the diverticulum and fully remove the scar through the light-transmitting positioning, the suture incision is good and the anatomy of the lower uterus is restored. It is safe and effective, and worthy of clinical application.

Key words: Cesarean section, Uterus, Diverticulum, Hysteroscopy, Laparoscopy