CAJ | 학술논문

目的：探讨宫腔镜联合B超检查诊断并联合腹腔镜治疗在剖宫产术后子宫切口憩室中的应用价值。方法对2011年3月—2013年2月在北京妇产医院行宫腔镜联合B超检查诊断并入院手术治疗的剖宫产术后子宫切口憩室患者27例的临床资料进行总结分析，通过宫腔镜联合B超检查测量憩室厚度值（憩室顶端至子宫浆膜层的最小距离）决定不同的手术治疗方案，对手术疗效、手术情况、并发症等进行评估。结果（1）27例患者中仅17例由经阴道B超检查诊断，与宫腔镜联合B超检查相比，单纯经阴道B超的诊断率为63%（17/27）。（2）以宫腔镜联合B超检查测量憩室厚度值为指标，其中<3 mm者19例，实施宫腔镜联合腹腔镜憩室切除修补术；憩室厚度值≥3 mm者8例，行宫腔镜憩室“开渠”术。（3）两种手术治疗的总有效率为85%（23/27），其中宫腔镜憩室“开渠”术治疗有效率为7/8，宫腔镜联合腹腔镜手术有效率为16/19，两种治疗方法的疗效比较，差异无统计学意义（P=0.663）。宫腔镜手术无效患者1例，憩室厚度值及其宽度与术前相比无明显变化；宫腔镜联合腹腔镜手术无效患者3例，憩室厚度值较术前增加，其宽度较术前缩小。结论（1）宫腔镜联合B超检查是诊断剖宫产术后子宫切口憩室的准确方法。（2）依据憩室厚度值选择手术方式，有利于减小创伤、提高治愈率。（3）手术中对憩室定位不准、切除不完整是影响疗效的主要原因。
목적：탐토궁강경연합B초검사진단병연합복강경치료재부궁산술후자궁절구게실중적응용개치。방법대2011년3월—2013년2월재북경부산의원행궁강경연합B초검사진단병입원수술치료적부궁산술후자궁절구게실환자27례적림상자료진행총결분석，통과궁강경연합B초검사측량게실후도치（게실정단지자궁장막층적최소거리）결정불동적수술치료방안，대수술료효、수술정황、병발증등진행평고。결과（1）27례환자중부17례유경음도B초검사진단，여궁강경연합B초검사상비，단순경음도B초적진단솔위63%（17/27）。（2）이궁강경연합B초검사측량게실후도치위지표，기중<3 mm자19례，실시궁강경연합복강경게실절제수보술；게실후도치≥3 mm자8례，행궁강경게실“개거”술。（3）량충수술치료적총유효솔위85%（23/27），기중궁강경게실“개거”술치료유효솔위7/8，궁강경연합복강경수술유효솔위16/19，량충치료방법적료효비교，차이무통계학의의（P=0.663）。궁강경수술무효환자1례，게실후도치급기관도여술전상비무명현변화；궁강경연합복강경수술무효환자3례，게실후도치교술전증가，기관도교술전축소。결론（1）궁강경연합B초검사시진단부궁산술후자궁절구게실적준학방법。（2）의거게실후도치선택수술방식，유리우감소창상、제고치유솔。（3）수술중대게실정위불준、절제불완정시영향료효적주요원인。
Objective To investigate the application of hysteroscopy combined ultrasonography and laparoscopy in the diagnose and treatment of post-cesarean section scar diverticulum (PCSD). Methods From March 2011 to February 2013, 27 patients with PCSD were diagnosed and treated in Beijing Obstetrics and Gynecology Hospital. All patients were diagnosed by hysteroscopy and ultrasonography. Treatment protocols were decided by the thickness of the diverticulum. The clinical data of all patients were analysed fully. Results (1)All patients were diagnosed by hysteroscopy combined ultrasound, of which only 17 cases were diagnosed by preoperative ultrasound, the coincidence rate was 63%(17/27). (2)The thickness of diverticulum was measured by hysteroscopy combined ultrasound. Thickness of less than 3 mm in 19 cases, were treated by hysteroscopy combined with laparoscopy diverticulectomy repair;no less than 3 mm in 8 cases, were used hysteroscopy diverticulum incision. (3)The effective rate was 7/8 after hysteroscopy, and which was 16/19 after laparoscopy combined with hysteroscopy surgery. There was no difference in the treatment effect (P=0.663). The ineffective rate was 1/8 after hysteroscopy, and which was 3/19 after laparoscopy combined with hysteroscopy surgery. The size of the PCSD was smaller and the thickness of diverticulum was thicker than preoperation in the later one, which has no difference in the former one. Conclusions (1)Hysteroscopy combined ultrasound is an accurate method for the diagnose of PCSD. (2)According to the thickness of the diverticulum operation method is choosed, which is beneficial to reduce the trauma, and relieve symptoms. (3)Diverticulum poor positioning and incomplete resection are the main causes of postoperative recurrence of the diverticulum.