Comparison Of The Efficacy Between Transvaginal Surgery And Laparoscopic-Hysteroscopic Surgery In The Treatment Of Cesarean Scar Diverticulum

Objective: To compare the clinical efficacy between transvaginal surgery and laparoscopic-hysteroscopic surgery in the treatment of cesarean scar diverticulum.Methods: Clinical data of 91 patients with Cesarean Scar Diverticulum who received surgical treatments in the hospital affiliated of Zunyi medical university from January2012 to January 2020 were collected and they were divided into transvaginal group 31 and laparoscopic-hysteroscopic group 60 according to different surgical methods.Analyzed the surgical efficacy,surgical conditions,the surgical complications retrospectively and following-up the pregnant outcome about the two groups.Results: 1.Surgical condition: The differences between the two groups in operation time,hospitalization cost,intraoperative bleeding and other indicators were significant(P<0.05).The laparoscopic-hysteroscopic surgery had longer operation time,more hospitalization cost and higher intraoperative bleeding.2.Surgical efficacy: The postoperative menstrual period and the diverticulum regression of transvaginal group and laparoscopic-hysteroscopic group were both followed for one year.The postoperative response rates of menstrual period was80.65% and 80.00%,(P>0.05);the diverticulum regression rate was 80.64% and53.33%,(P>0.05);There were no significant differences between the two groups,the total response rates was 80.64% and 80.00%,(P>0.05).3.Efficacy of CSD patients with different uterine positions: In the laparoscopic-hysteroscopic group,the postoperative response rates of anterior uterus and posterior flexion uterus were 83.72% and 70.59%,there were no significant differences between the two groups,(P>0.05).In the transvaginal group,the postoperative response rates were 86.36% and 66.67%,there was significant differences between the two groups,(P<0.05).4.Efficacy of CSD patients with degree I mild uterine prolapse: the postoperative response rate of the transvaginal group and laparoscopic-hysteroscopic group were 100.00%,and 70.00%,and there was significant difference between the groups,(P<0.05).5.Pregnancy outcome: Two years after surgery,in the laparoscopic-hysteroscopic group 44 patients who were willing to become pregnant,21 patients had successful pregnancies 47.73%.In the transvaginal group,26 patients who had the pregnant desire,4 patients conceived 15.38%.There was significant difference between the groups,(P<0.05).6.Complications: One case in the laparoscopic-hysteroscopic group was transferred from laparoscopy to laparotomy due to severe pelvic adhesion.There were no complications in the transvaginal group;neither laparoscopic-hysteroscopic group nor transvaginal group had the pregnant abnormalities such as uterine rupture or cesarean scar pregnancy.Conclusion: Both the transvaginal surgery and the laparoscopic-hysteroscopic surgery can treat the CSD effectively and safely,the efficacy of both group had no difference;The transvaginal surgery can reduce the intraoperative bleeding and hospitalization costs,can also shorter surgical time and make less operative complications than the laparoscopic-hysteroscopic surgery;the transvaginal surgery in the treatment of CSD patients with anteflexion uterus is superior to retroflexion uterus,especially for the CSD patients with degree I mild uterine prolapse,it can better expose the position of incision scar and has a more superior efficacy;the laparoscopic-hysteroscopic surgery can detect other lesions affecting infertility in abdominal cavity and uterine cavity in surgery,so it’s a worthy surgical method to recommend for the CSD patients with pregnancy intention...