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| Effect evaluation of hysteroscopic niche resection and laparoscopic repair with hysteroscopy in the treatment of post-cesarean scar diverticulum |
| SUN Huiting JU Huamei LIU Sufen YU Jiajun SHI Ruxia CHEN Liping▲ |
| Center of Reproduction, the Affiliated Changzhou NO.2 People′s Hospital of Nanjing Medical University, Jiangsu Province, Changzhou 213000, China |
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Abstract Objective To investigate the efficacy of laparoscopic repair with hysteroscopy and hysteroscopic niche resection in the treatment of post-cesarean scar diverticulum. Methods From January 2016 to November 2018, 42 cases with post-cesarean scar diverticulum in the Affiliated Changzhou NO.2 People′s Hospital of Nanjing Medical University were selected. According to the surgical methods, they were divided into the hysteroscopic niche resection group and the laparoscopic repair with hysteroscopy group, with 21 cases in each group. The hysteroscopic niche resection group was performed simple hysteroscopic niche resection, while the laparoscopic repair with hysteroscopy group was performed laparoscopic repair with hysteroscopy. The operation time, intraoperatve blood loss, hospital stay length and hospital expenses and postoperative pregnancy were compared between two groups. Results The operation time, intraoperatve blood loss, hospital stay length, hospital expenses of the hysteroscopic niche resection group were lower than those of the laparoscopic repair with hysteroscopy group, and the differences were statistically significant (P < 0.05 or P < 0.01). There was no significant difference in the clinical effect at 1 month after surgery between two groups (P > 0.05). The clinical effect at 3 and 6 months after surgery of the laparoscopic repair with hysteroscopy group were higher than those of the hysteroscopic niche resection group, and the differences were statistically significant (P < 0.05). Postoperative pregnancy of the laparoscopic repair with hysteroscopy group were higher than those of the hysteroscopic niche resection group. Conclusion Both surgical methods have achieved certain clinical effect in the treatment of post-cesarean scar diverticulum.The laparoscopic repair with hysteroscopy of PCSD is safer and more effective, has more satisfactory menstrual recovery, should widely use to treat patients with PCSD.
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[1] Zhang Y. A comparative study of transvaginal repair and laparoscopic repair in the management of patients with previous cesarean scar defect [J]. J Minim Invasive Gynecol，2016，23（4）：535-541.
[2] Erickson SS，Van Voorhis BJ. Intermenstrual bleeding secondary to cesarean scar diverticuli：report of three cases [J]. Obstet Gynecol，1999，93（5 Pt 2）：802-805.
[3] 汪沙，段华.剖宫产瘢痕憩室的形成机制及诊断[J].中国实用妇科与产科杂志，2018，34（8）：858-861.
[4] Wang CB，Chiu WW，Lee CY，et al. Cesarean scar defect：correlation between cesarean section number，defect size，clinical symptoms and uterine position [J]. Ultrasound Obstet Gynecol，2009，34（1）：85-89.
[5] Vikhareva Osser O，Valentin L. Risk factors for incomplete healing of the uterine incision after caesarean section [J]. BJOG，2010，117（9）：1119-1126.
[6] Ofili-Yebovi D，Ben-Nagi J，Sawyer E，et al. Deficient lower-segment cesarean section scars：prevalence and risk factors [J]. Ultrasound Obstet Gynecol，2008，31（1）：72-77.
[7] Van der Voet LF，Vervoort AJ，Veersema S，et al. Minimally invasive therapy for gynaecological symptoms related to a niche in the caesarean scar：a systematic review [J]. BJOG：Int J Obstet Gy，2014，121（2）：145-156.
[8] Tahara M，Shimizu T，Shimoura H. Preliminary report of treatment with oral contraceptive pills for intermenstrual vaginal bleeding secondary to a cesarean section scar [J]. Fertil Steril，2006，86（2）：477-479.
[9] 张燕茹，黄惠娟.剖宫产术后子宫切口憩室的诊治进展[J].中国计划生育学杂志，2017，25（7）：494-497，501.
[10] Li C，Tang S，Gao X，et al. Efficacy of combined laparoscopic and hysteroscopic repair of post-cesarean section uterine diverticulum：a retrospective analysis [J]. Biomed Res Int，2016，2016：1 765 624.
[11] 丁景新，陈建亮，张宏伟，等.宫腹腔镜联合修补剖宫产术后子宫切口憩室[J].复旦学报：医学版，2012，39（5）：506-510.
[12] 张宁宁，王光伟，杨清.腹腔镜下不同方法修复剖宫产子宫瘢痕憩室的临床疗效分析[J].中国医科大学学报，2017，46（9）：853-856.
[13] 章烨，谢华芳，高毅等.宫腔镜电凝术与阴式手术治疗子宫切口瘢痕憩室的疗效对比[J].临床和实验医学杂志，2019，18（4）：434-436.
[14] Wang CJ，Huang HJ，Chao A，et al. Challenges in the transvaginal management of abnormal uterine bleeding secondary to cesarean section scar defect [J]. Eur J Obstet Gynecol Reprod Biol，2011，154（2）：218-222.
[15] Tanimura S，Funamoto H，Hosono T，et al. New diagnostic criteria and operative strategy for cesarean scar syndrome：Endoscopic repair for secondary infertility caused by cesarean scar defect [J]. J Obstet Gynaecol Res，2015，41（9）：1363-1369.
[16] Lv B，Xie X，Liu C，Lin Y. Laparoscopic combined with hysteroscopic repair or operative hysteroscopy in the treatment of symptomatic cesarean-induced diverticulum [J]. Med Sci（Paris），2018，34 Focus issue F1：47-51.
[17] Li S，Tang L，Zhou Q. Hysteroscopy combined with laparoscopy in treatment of patients with post-cesarean section uterine diverticulum [J]. Wideochir Inne Tech Maloinwazyjne，2019，14（2）：297-303.
[18] 申迪，肖丽，李秋丽，等.宫、腹腔镜联合手术与其他术式治疗剖宫产瘢痕憩室的疗效分析[J].腹腔镜外科杂志，2019，24（1）：53-56.
[19] 张世妹，周丹.剖宫产子宫瘢痕憩室诊断和治疗进展[J].中国实用妇科与产科杂志，2015，31（2）：174-176.
[20] Liu SJ，Lv W，Li W. Laparoscopic repair with hysteroscopy of cesarean scar diverticulum [J]. J Obstet Gynaecol Res，2016，42（12）：1719-1723. |
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