Department of Gynecology, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan (Drs. Deng, Chen, Lin, Huang, X. Liu, Zheng); Department of Gynecology, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde) (Dr. Deng), Foshan.
Department of Gynecology, Shenzhen In Vitro Fertilization Gynecological Hospital (Drs. W. Liu, Wu, H. Wang, J. Wang, and Chen), Shenzhen, Guangdong, China.
J Minim Invasive Gynecol. 2021 May;28(5):1051-1059. doi: 10.1016/j.jmig.2020.12.009. Epub 2020 Dec 14.
To analyze retrospectively the effect of hysteroscopy combined with transvaginal repair on the cesarean section diverticulum (CSD) and explore the clinical significance of this procedure.
Retrospective study.
University-affiliated hospital and a gynecology hospital.
A total of 183 patients with scar diverticulum after cesarean section were recruited from the Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan and Shenzhen In Vitro Fertilization Gynecological Hospital.
In this study, we reported a surgical method for repairing uterine scar through uterine therapy and explored its clinical efficacy and pregnancy outcome.
The time of operation, volume of bleeding, and duration of hospitalization were recorded. The size of the scar diverticulum and the remaining myometrium were examined by B-mode ultrasonography before and after the operation. The length of the menstrual cycle and pelvic pain were recorded during follow-up to check the recovery of patients after surgery. The pregnancy of patients with pregnancy needs was recorded to check the pregnancy outcome. All 183 patients successfully completed the repair of the transvaginal uterus scar diverticulum with the help of a hysteroscopy examination. The mean (± standard deviation) operation time was 58.61 ± 18.56 minutes. The mean blood loss was 36.97 ± 22.32 mL. The mean hospital stay was 6.08 ± 1.89 days. In 57.14% of patients, the CSD completely disappeared, whereas the volume of CSD shrank by at least 50% in 88.95% of patients. The mean menstrual period of patients after surgery was 7.72 ± 2.68 days, which was significantly shorter than that recorded preoperatively (13.45 ± 3.69 days) (t = 19.62, p = .00). The pelvic pain disappeared in 81.08% of the patients. The mean postoperative thickness of the remaining muscular layer was 5.30 ± 1.27-mm, which was significantly higher than the preoperative value of 2.25 ± 0.92-mm (t = 28.21, p = .00). The mean postoperative thickness of the remaining muscular layer of patients with improved menstrual cycle was 5.40 ± 1.27-mm, which was significantly higher than the thickness of 4.88 ± 1.11-mm in patients without improved menstrual cycle (t = 2.31, p = .025). A total of 124 patients attempted to become pregnant, 83 of whom were successful. The pregnancy rate was as high as 66.95%, which included 2 scar pregnancies, 4 ectopic pregnancies, and 87 intrauterine pregnancies. No uterine rupture occurred.
The transvaginal repair of the uterine diverticulum improved the symptoms and probability of a successful pregnancy effectively. This process is a surgical procedure to increase the thickness of the residual uterine muscle wall effectively.
回顾性分析宫腔镜联合经阴道修补术治疗剖宫产憩室（CSD）的效果，并探讨该术式的临床意义。
回顾性研究。
大学附属医院和妇科医院。
本研究共纳入南方医科大学附属佛山妇幼保健院和深圳爱维艾夫妇科医院的 183 例剖宫产术后瘢痕憩室患者。
本研究报道了一种通过子宫治疗修复子宫瘢痕憩室的手术方法，并探讨了其临床疗效和妊娠结局。
记录手术时间、出血量和住院时间。术前和术后均采用 B 型超声检查憩室大小和剩余子宫肌层厚度。随访记录月经周期长度和盆腔疼痛，以检查患者术后恢复情况。记录有妊娠需求患者的妊娠情况，以检查妊娠结局。所有 183 例患者均在宫腔镜检查的帮助下成功完成经阴道子宫憩室修补术。手术时间平均（±标准差）为 58.61±18.56 分钟。平均出血量为 36.97±22.32mL。平均住院时间为 6.08±1.89 天。在 57.14%的患者中，CSD 完全消失，而在 88.95%的患者中，CSD 体积缩小至少 50%。术后患者的平均月经周期为 7.72±2.68 天，明显短于术前的 13.45±3.69 天（t=19.62，p=.00）。81.08%的患者盆腔疼痛消失。术后剩余肌层平均厚度为 5.30±1.27mm，明显高于术前的 2.25±0.92mm（t=28.21，p=.00）。月经周期改善的患者术后剩余肌层平均厚度为 5.40±1.27mm，明显高于月经周期未改善患者的 4.88±1.11mm（t=2.31，p=.025）。共有 124 例患者尝试妊娠，其中 83 例成功。妊娠率高达 66.95%，包括 2 例瘢痕妊娠、4 例异位妊娠和 87 例宫内妊娠。未发生子宫破裂。
经阴道修补术可有效改善憩室症状和提高妊娠成功率。该过程是一种可有效增加残留子宫肌壁厚度的手术方法。
