引用本文:刘媛媛,赵仁峰.三种不同切除术治疗剖宫产子宫切口瘢痕憩室的疗效比较[J].中国临床新医学,2019,12(11):1217-1220.
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三种不同切除术治疗剖宫产子宫切口瘢痕憩室的疗效比较
刘媛媛,赵仁峰
530021 南宁,广西壮族自治区人民医院妇科
摘要:
[摘要] 目的 比较三种不同切除术治疗剖宫产子宫切口瘢痕憩室的临床疗效。方法 选取2014-12~2017-12该院收治的45例剖宫产子宫切口瘢痕憩室患者,按照随机分配的方法分成3组,每组15例,分别行经腹憩室切除术(A组)、宫腹腔镜联合憩室切除术(B组)、阴式憩室切除术(C组)。比较三组手术时间、术中出血量、术后阴道出血量、术后肛门排气时间、住院时间、住院费用及治愈率。结果 A组在手术时间、术中出血量、术后阴道出血量、术后肛门排气时间、术后住院时间方面均高于其他两组,住院费用低于其他两组,差异有统计学意义(P<0.05)。B组的手术时间、住院时间、住院费用多于C组,术后肛门排气时间晚于C组,差异有统计学意义(P<0.05)。B、C两组在术中出血量、术后阴道出血量方面差异无统计学意义(P>0.05)。C组手术时间、肛门排气时间、住院时间最短。结论 三种妇科手术各有优势,对于子宫瘢痕憩室均有很高的治愈率。经腹憩室切除术容易操作,视野清楚,住院费用低,但是出血量较多,术后恢复慢,住院时间长;宫腹腔镜联合手术时间较长、住院费用高,损伤小,术后恢复快;阴式手术住院费用适中,疗效确切,但手术视野小、暴露困难。应根据患者的实际情况选择合适的手术方式。
关键词:  剖宫产子宫切口瘢痕憩室  开腹手术  宫腹腔镜联合手术  阴式手术
DOI:10.3969/j.issn.1674-3806.2019.11.18
分类号:R 711
基金项目:
Comparison of the therapeutic effects of three kinds of resection for previous cesarean scar defects
LIU Yuan-yuan, ZHAO Ren-feng
Department of Gynecology, the People′s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
Abstract:
[Abstract] Objective To compare the clinical effects of three kinds of resection for previous cesarean scar defects(PCSD). Methods A total of 45 patients who suffered from PCSD were enrolled into this study from December 2014 to December 2017, among whom 15cases were performed laparotomy(group A), and 15 cases were performed hysteroscopy combined with laparoscopy(group B), and 15 cases were performed vaginal surgery(group C). The operation time, intraoperative blood loss, postoperative vaginal bleeding volume, postoperative anal exhaust time, hospitalization time, hospitalization costs and cure rate were compared among the three groups. Results The intraoperative blood loss, postoperative vaginal bleeding and hospitalization costs in group A were significantly higher than those in group B and group C(P<0.05). The operation time and postoperative hospitalization time in group A was significantly longer than that in group B and group C(P<0.05). The postoperative anal exhaust time in group A was significantly earlier than that in group B and group C(P<0.05). The operation time and hospitalization time in group B was significantly longer than that in group C(P<0.05). The hospitalization costs in group B were higher than those in group C(P<0.05). The postoperative anal exhaust time in group B was significantly later than that in group C(P<0.05). There were no significantly differences between group B and group C in the intraoperative blood loss and postoperative vaginal bleeding volume(P>0.05). Among the three groups, group C had the shortest the operation time and postoperative hospitalization time and the earliest postoperative anal exhaust time. Conclusion Each of the three types of minimally invasive surgery has its advantages, and they have high cure rates. Laparotomy is the easiest way and has the clearest vision and lowest hospitalization costs but causes the largest blood loss and the patients have the slowest postoperative recovery and the longest hospital stay. Hysteroscopy combined with laparoscopic operation has the longest operative time and highest hospitalization costs, but the patients have the smallest damage and quickest recovery. The hospitalization costs of the patients receiving vaginal surgery are moderate and their curative effects are definite, but the disadvantages of the operation are small visual field and exposure. The appropriate operation method should be selected according to the actual situation of the patients.
Key words:  Previous cesarean scar defects(PCSD)  Laparotomy  Hysteroscopy combined with laparoscopy  Vaginal surgery