Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
J Invest Surg. 2021 Oct;34(10):1147-1155. doi: 10.1080/08941939.2020.1766161. Epub 2020 May 13.
To compare the incidence of postmenstrual bleeding after hysteroscopic resection versus laparoscopic repair of previous cesarean scar defect (PCSD).
Retrospective analysis of computerized patient records. For the diagnosis of PCSD, patients underwent transvaginal ultrasound first without and then with saline-assisted sonohysterography. Hysteroscopic PCSD resection was performed under sonographic guidance, while laparoscopic repair was guided by hysteroscopy for the confirmation of scar margins.
Records of 62 patients presenting with PCSD-related postmenstrual bleeding were included in analysis. Hysteroscopic surgery had significantly shorter operative time compared to the laparoscopic approach (Mean =30.9 vs 71.0 minutes; < 0.001). Blood loss and hospital stay were significantly less ( < 0.001) in hysteroscopic resection (10.4 ± 4.6 ml and 2.1 ± 0.4 days) than in laparoscopic repair (36.6 ± 4 ml, and 4.6 ± 1 days). After surgical interventions, the postmenstrual bleeding was resolved or improved. The effectiveness rates of hysteroscopic resection and laparoscopic repair were 91.4% and 96.3%, respectively. Incidence of post-treatment postmenstrual bleeding was not significantly different between hysteroscopy and laparoscopy (OR= 1.29 [95% confidence interval 0.367, 4.86]; = 0.662). Pretreatment postmenstrual bleeding was associated with time since cesarean section (B= -0.091 [-0.158, -0.023]; = 0.01) and PCSD length (B = 0.502 [0.085, 0.919]; = 0.019).
Both hysteroscopic resection and laparoscopic repair of PCSD yield comparable efficacy in reducing postmenstrual bleeding. However, hysteoroscopic resection of PCSD is associated with comparatively shorter operative time, less blood loss, and shorter hospital stay.
比较宫腔镜切除与腹腔镜修复剖宫产术后子宫瘢痕缺陷（PCSD）后月经过多的发生率。
回顾性分析计算机化的患者记录。为了诊断 PCSD，患者首先接受经阴道超声检查，然后进行盐水辅助超声造影。宫腔镜下 PCSD 切除术在超声引导下进行，腹腔镜修复术则在宫腔镜下引导以确认瘢痕边缘。
共有 62 例因 PCSD 相关月经过多就诊的患者被纳入分析。宫腔镜手术的手术时间明显短于腹腔镜方法（Mean=30.9 vs 71.0 分钟； < 0.001）。宫腔镜切除术中出血量和住院时间明显少于腹腔镜修复术（10.4±4.6 ml 和 2.1±0.4 天）（ < 0.001）。手术干预后，月经过多得到缓解或改善。宫腔镜切除术和腹腔镜修复术的有效率分别为 91.4%和 96.3%。宫腔镜和腹腔镜治疗后，月经过多的发生率无显著差异（OR=1.29 [95%置信区间 0.367, 4.86]； = 0.662）。术前月经过多与剖宫产时间（B= -0.091 [-0.158, -0.023]； = 0.01）和 PCSD 长度（B=0.502 [0.085, 0.919]； = 0.019）相关。
宫腔镜切除与腹腔镜修复 PCSD 均可有效减少月经过多。然而，宫腔镜下 PCSD 切除术的手术时间、出血量和住院时间相对较短。
