Lv Bingqing, Xie Xi, Liu Chaobin, Lin Yuan
Department of Gynecology and Obstetrics, Fujian Province Maternity and Children's Hospital, affiliated hospital of Fujian Medical University, No.18 Anshan Road, Gulou District Fuzhou City, Fujian Province 350001, PR China.
Med Sci (Paris). 2018 Oct;34 Focus issue F1:47-51. doi: 10.1051/medsci/201834f109. Epub 2018 Nov 7.
The postmenstrual bleeding with cesarean-induced diverticulum is a bothersome symptom and can be confused with other abnormal-uterine bleeding disease. The aim of the present study was to evaluate the efficacy and safety of laparoscopic combined with hysteroscopic repair vs operative hysteroscopy in treatment of symptomatic cesarean-induced diverticulum.
Eighty-two women with cesarean-induced diverticulum who underwent either laparoscopic combined with hysteroscopic repair or operative hysteroscopy between January 2012 and September 2015 were retrospectively included in the study. We evaluated the menstrual duration before and after the surgery, the width, length and depth of the niche, operating time, blood loss, complications, and postoperative pregnancy status.
62.2% (51/82) patients started to have postmenstrual bleeding immediately when they gained regular menstruation after their cesarean section. The laparoscopic group has longer operative time and greater blood loss (p<0.001). Both groups have a significant improvement in their menstruation duration ( p< 0.001). The patients in the laparoscopic repair group had a greater improvement in bringing the uterine bleeding into normal menstruation duration (P=0.046) and the same in pregnancy rate (P=0.505). The interval between operation and pregnancy in laparoscopic combined with hysteroscopic group was much longer than the hysteroscopic group (27 vs 10 months, p<0.001).
the laparoscopic repair exhibited a better efficiency in bringing the uterine bleeding into normal menstruation duration and in improving the pregnancy rate However, there was not a clear absolute advantage for one of the two type of surgeries. Thus, patients with post-cesarean section diverticulum (PCSD) should choose with caution the type of surgery, considering the residual myometrial thickness (RMT), the age, the desire for further fertility and ovarian reserve capacity.
剖宫产术后憩室引起的经期后出血是一种令人困扰的症状，可能与其他异常子宫出血疾病相混淆。本研究的目的是评估腹腔镜联合宫腔镜修复术与宫腔镜手术治疗有症状的剖宫产术后憩室的疗效和安全性。
回顾性纳入2012年1月至2015年9月期间接受腹腔镜联合宫腔镜修复术或宫腔镜手术的82例剖宫产术后憩室患者。我们评估了手术前后的月经持续时间、憩室的宽度、长度和深度、手术时间、失血量、并发症及术后妊娠情况。
62.2%（51/82）的患者剖宫产术后月经恢复正常时立即出现经期后出血。腹腔镜组手术时间更长，失血量更多（p<0.001）。两组患者的月经持续时间均有显著改善（p<0.001）。腹腔镜修复组患者在使子宫出血恢复正常月经持续时间方面有更大改善（P=0.046），妊娠率相同（P=0.505）。腹腔镜联合宫腔镜组手术与妊娠之间的间隔时间比宫腔镜组长得多（27个月对10个月，p<0.001）。
腹腔镜修复术在使子宫出血恢复正常月经持续时间和提高妊娠率方面表现出更好的效果。然而，两种手术方式中没有一种具有明显的绝对优势。因此，剖宫产术后憩室患者应谨慎选择手术方式，考虑剩余肌层厚度（RMT）、年龄、进一步生育的愿望和卵巢储备功能。
