Retrospective Analysis Of The Clinical Effects Of Hysteroscopy Combined With Laparoscopy Operation On Uterine Scar Diverticulum After Cesarean Section

Background and objectiveCesarean section is an important therapeutic method for high-risk pregnancy and dystocia. The rate of cesarean section show a rising trend year by year in China, especially in the last ten years. Many studies reported the rate of cesarean section was about 40% ~ 70%. With the increase of the rate of cesarean section, complications of uterine incision occurred continuously, such as incision diverticulum, uterine incision pregnancy, poor healing of incision and so on which had a serious impact on mothers and fetuses. This has become one of the important clinical problems which attract more and more attentions of gynecologist. Ischemia or infection in uterine incisions of delivery women may lead to tissue necrosis, and then wound dehiscence known as poor healing of uterus incision. If the infection is serious, operation treatment was needed to repair incision, even complete hysterectomy. Although the conservative treatment has a high success rate, but incision diverticulum and incision pregnancy may occure in the long term. Uterine incision sag known as uterine incision scar diverticulum happened due to the healing defects, common to left, right and front walls of cervix. Residual blood was easy to accumulate in the uterine diverticula, which may lead to menostaxis and aciesis. Hysterorrhexis and incision scar pregnancy may happened if pregnant again. Previous uterine scar diverticulum diagnosis rate was lower due to limited diagnosis technology, abnormal uterine bleeding usually was treated as dysfunctional uterine bleeding. In recent years, hysteroscopy technology has been widely applied in linical practice and the diagnosis rate of uterine scar diverticulum were remarkably improved. No treatment was unified for uterine scar diverticulum untill now. The common therapeutic methods include drug, resection of the diverticulum per vaginam, resection of the diverticulum by hysteroscope. The operation effect is good, and different ways of operation of uterine scar diverticulum were explored at home and abroad. The clinical effects of hysteroscopy combined with laparoscopy peration on uterine scar were retrospective analyzed in this study to provide a certain eference value for clinical treatment.Methods32 patients with hysteroscopy combined with uterine scar diverticulum after cesarean section treated by laparoscopy operation in the First Affiliated Hospital of Zhengzhou University from July 2011 to December were selected. The operation time, amount of bleeding, recovery, the improvement of the symptoms, recurernce rate were analyzed.ResultsThe operations were successfully completed in 32 patients. There was no patient treated with conversion to open operation and transfusion. No accident happened in the process of operation and anesthesia. Operation time was 60~90 min with an average of(83.27±22.87) minutes. The amounts of bleeding were 35~95 ml with with an average of(67.32±18.89)ml. all patients had no complications such as vaginal infection, vesicovaginal fistula and bladder injury after operation. The clinical symptoms improved significantly, menstrual cycle before opereation was(15.36±3.57)d, menstrual cycle after opereation was(8.60±1.37)d, the different was statistically significant(t=6.760,P<0.05). There was 1 case of recurrence.ConclusionsThe clinical effects of hysteroscopy combined with laparoscopy operation on uterine scar diverticulum after cesarean section were well with shorter operation time and less amount of bleeding. This treatment could significantly improve the clinical symptom and deserve the clinical expansion.