| Purpose:Through retrospective observation and analysis of 647 patients with previous cesarean scar defect,the clinical effects of cesarean scar defect repairs through transvaginal operation,hysteroscopic cesarean scar defect electrotomy,hysteroscopy combined with laparoscopy open suture surgery,and hysteroscopy combined with laparoscopy folding and suture surgery were compared to discuss different patients with cesarean scar defect how to choose the most suitable treatment ways.In addition,by comparing the re-pregnancy outcomes of patients after the repairs of previous cesarean scar defect with those without the repairs of previous cesarean scar defect,it is necessary to explore whether it is necessary for those who have fertility requirements for the patients who have suffered previous cesarean scar defect to undergo the repair of womb defect.Methods:From January 1,2016 to December 31,2020 in the Hospital,transvaginal sonography diagnosis of 647 patients with previous cesarean scar defect were there because of menstrual bleeding profusely don’t clean hands performer in 288 cases(146 cases for hysteroscopy electrotomy,33 cases of cesarean scar defect repairs through transvaginal operation and 63 cases of hysteroscopy combined with laparoscopy open suture surgery,46 cases of hysteroscopy combined with laparoscopy folding and suture surgery).Among them,274 cases had fertility requirements,97 cases got got re-pregnant without any cesarean scar defect repairs and 22 cases got got re-pregnant after cesarean scar defect repairs.After grouping the data,SPSS 25 statistical software was used for data analysis.Because the distribution was not normal,the measurement data was represented by median(Quartile Range),the difference between groups was tested by rank sum test,the count data was described by frequency and rate,and the comparison between groups was tested by X2 test.Results:1.There was no statistical significance in age,times of cesarean section,prolonged menstrual period,dysmenorrhea,infertility and other general data of the four surgical methods for repairing previous cesarean scar defect due to abnormal uterine bleeding(P > 0.05),and they were comparable.In terms of intraoperative blood loss and length of stay,the hysteroscopy group was the least,and there was no statistical significance in pair comparison between hysteroscopy combined with laparoscopy open suture surgery and hysteroscopy combined with laparoscopy folding and suture surgery group and vaginal group(P > 0.0083).In terms of operation time,the laparoscopic previous cesarean scar defect incision and suture group was the longest,the laparoscopic previous cesarean scar defect folding and suture group was the second,the vaginal group was the third,and the hysteroscopic group was the shortest.In terms of treatment costs,the expenses of previous cesarean scar defect folding and suturing group were higher than those of previous cesarean scar defect incision and suturing group,but there was no statistical difference between the two groups(P > 0.0083).The cost of hysteroscopy group and vaginal group was lower,but there was no statistical difference between the two groups.(P > 0.0083).Four total effective surgical pairwise comparison results: hysteroscopy group respectively and Yin type,palace,hysteroscopy combined with laparoscopy open suture surgery,hysteroscopy combined with laparoscopy folding and suture surgery,the difference had statistical significance(P < 0.0083),Yin type,palace,hysteroscopy combined with laparoscopy open suture surgery,palace,hysteroscopy combined with laparoscopy folding and suture surgery two comparison between three groups had no statistical difference(P > 0.0083).2.The patients with previous cesarean scar defect with fertility requirements were divided into the group after previous cesarean scar defect repair and the group without previous cesarean scar defect repair.There was no statistical significance in age,frequency of cesarean section,interval time between cesarean section and other general data between the two groups(P > 0.05),indicating comparability.There were274 patients with previous cesarean scar defect with fertility requirements,among which 213 patients had fertility requirements without previous cesarean scar defect repair,97 patients had fertility requirements after previous cesarean scar defect repair,61 patients had fertility requirements after previous cesarean scar defect repair,22 patients had fertility requirements after previous cesarean scar defect repair.Two groups of scar pregnancy rate,rate of incomplete uterine rupture,days of pregnancy,such as comparison,the difference was statistically significant(P < 0.05),secondary infertility,spontaneous abortion rate,implantation rate,rate of placenta previa,placenta fetal weight,and Apgar score,contractions fatigue rate,the comparison of postpartum haemorrhage amount and rate of postpartum hemorrhage,there were no statistically significant difference(P > 0.05).Conclusions:1.Surgical treatment of cesarean scar defect repairs can effectively improve the symptoms of abnormal uterine bleeding in patients.Hysteroscopy has the lowest effective rate and is not recommended,although it has small trauma,short operation time,less vaginal bleeding and low hospitalization2.Cesarean scar defect repair is the first choice for the treatment of abnormal uterine bleeding because of its low operation cost,short operation time and high effective rate.3.Cesarean scar defect repairs can effectively reduce scar pregnancy rate and incomplete uterine rupture rate,and increase the number of days of pregnancy.Therefore,transvaginal uterine diverticulum repair,laparoscopic uterine scar diverticulum incision and suture or laparoscopic uterine scar diverticulum folding and suture are recommended first for patients with uterine scar diverticulum if they have fertility requirements.4.Cesarean scar defect repair is recommended for patients who have fertility requirements for uterine scar diverticulum during cesarean section if they have no recent fertility requirements.If there are recent fertility requirements,uterine laparoscopic folding and suturing of uterine diverticulum is recommended.. |
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