Cheng Shiyu, Gao Han, Li Yanli, Li Xin, Meng Tingzhu, Teng Dan, Du Mei, Deng Dongqin, Liu Jing, Ouyang Xiyan, Chai Lingna, Shi Jie
Department II of Gynecology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430070, China.
Medical College, Wuhan University of Science and Technology, Wuhan, China.
BMC Pregnancy Childbirth. 2025 May 14;25(1):573. doi: 10.1186/s12884-025-07667-0.
To evaluate and compare the long-term therapeutic effect and the re-pregnant outcomes of hysteroscopic resection and laparoscopic defect repair in the treatment of non-severe cesarean scar defect (CSD).
The clinical data of 154 CSD patients whose residual myometrium thickness (RMT) ≥ 3 mm that treated at Maternal and Child Health Hospital of Hubei Province from January 2019 to May 2022 were retrospectively analyzed (74 accepted hysteroscopic resection and 80 received laparoscopic defect repair). We compared the general clinical data, laboratory tests, surgical related indicators and perioperative complications of two groups of patients, followed up and recorded the menstrual days at the 3rd, 6th, and 12th months after surgery, as well as the obstetric outcomes of re-pregnant patients.
The surgical duration, intraoperative bleeding, postoperative vaginal bleeding days, hospital stay, and total treatment cost in hysteroscopic group were all obviously lower than those in laparoscopic group. More importantly, the incidence of postoperative complications such as fever and pelvic pain was also significantly lower in patients undergoing hysteroscopic surgery than those undergoing laparoscopic surgery. In terms of menstrual improvement, at the postoperative 3rd,6th and 12th month, the patients of hysteroscopic group had shorter menstrual days than laparoscopic group. Additionally, the postoperative re-pregnancy rate of hysteroscopic group (61.29%) was higher than that of laparoscopic group (55%). No serious obstetric complications such as placenta implantation and uterine rupture occurred in the re-pregnant patients of both groups.
Although both hysteroscopic resection and laparoscopic defect repair have good clinical effects on improving the symptoms of non-severe CSD patients. But in contrast, the hysteroscopic resection displays the advantages of minimal trauma, shorter surgical time, less intraoperative bleeding, shorter hospital stay, lower treatment costs, faster postoperative recovery, lower incidence of postoperative complications, and higher re-pregnancy rate. Hence, hysteroscopic resection is safe and effective, and could be the first choice for the treatment of no-severe CSD patients.
评估和比较宫腔镜切除术与腹腔镜缺损修复术治疗非重度剖宫产瘢痕缺损（CSD）的长期治疗效果及再次妊娠结局。
回顾性分析2019年1月至2022年5月在湖北省妇幼保健院接受治疗的154例残余肌层厚度（RMT）≥3 mm的CSD患者的临床资料（74例行宫腔镜切除术，80例行腹腔镜缺损修复术）。比较两组患者的一般临床资料、实验室检查、手术相关指标及围手术期并发症，随访并记录术后3个月、6个月和12个月的月经天数以及再次妊娠患者的产科结局。
宫腔镜组的手术时间、术中出血量、术后阴道出血天数、住院时间及总治疗费用均明显低于腹腔镜组。更重要的是，宫腔镜手术患者术后发热、盆腔疼痛等并发症的发生率也显著低于腹腔镜手术患者。在月经改善方面，术后3个月、6个月和12个月，宫腔镜组患者的月经天数短于腹腔镜组。此外，宫腔镜组的术后再次妊娠率（61.29%）高于腹腔镜组（55%）。两组再次妊娠患者均未发生胎盘植入、子宫破裂等严重产科并发症。
虽然宫腔镜切除术和腹腔镜缺损修复术对改善非重度CSD患者症状均有良好的临床效果。但相比之下，宫腔镜切除术具有创伤小、手术时间短、术中出血少、住院时间短、治疗费用低、术后恢复快、术后并发症发生率低及再次妊娠率高等优点。因此，宫腔镜切除术安全有效，可作为非重度CSD患者的首选治疗方法。
