Clinical Effect Of Hysteroscopy Combined With Transvaginal Folding Suture On The Treatment Of Cesarean Scar Diverticulum

Objective: The clinical data of 37 patients with cesarean scar diverticulum(CSD)who received surgery were analyzed.The perioperative indexes and postoperative effects of hysteroscopy combined with transvaginal folding suture and hysteroscopy combined with transvaginal incision suture were compared to evaluate the clinical effect of hysteroscopy combined with transvaginal folding suture on the treatment of CSD.Method: 37 patients diagnosed as CSD by vaginal ultrasound in Anqing Municipal Hospital from June 2016 to March 2022 were chosen.Among them,20 patients received hysteroscopy combined with transvaginal folding suture(study group),and17 cases received hysteroscopy combined with transvaginal incision suture(control group).The following clinical materials of two groups were collected: age,pre-cesarean section menstrual period,duration of preoperative menstrual period,preoperative residual myometrium thickness,length of the diverticulum,width of the diverticulum,depth of the diverticulum,the number of cesarean sections,the time between the surgery and the last cesarean section,preoperative hemoglobin concentration,operation time,intraoperative bleeding,maximal postoperative body temperature,postoperative vaginal bleeding time,the length of hospitalization,postoperative pathology,the following-up postoperative symptom improvement,postoperative myometrial thickness of lower uterine segment,postoperative pregnancy.Statistical software SPSS17.0 was used to analyze the data.Results: 1.There were no significant differences in age,the pre-cesarean section menstrual period,the duration of preoperative menstrual period,the preoperative residual myometrium thickness,the length of the diverticulum,the width of the diverticulum,the depth of the diverticulum,the number of cesarean sections,the time between the surgery and the last cesarean section,and preoperative hemoglobin concentration between the patients in the two groups.2.The operation time of the study group and the control group was(70.75±9.07)min and(83.53±14.12)min,the difference between which was statistically significant(t=-3.33,P=0.02).The amount of bleeding in the study group and the control group was(27.00±12.18)ml,(37.06±11.60)ml,the difference between which was statistically significant(t=-2.56,P=0.02).There was no statistical significance in the postoperative vaginal bleeding time,the maximal postoperative body temperature and hospitalization time between two groups(all P>0.05).Postoperative pathological results:In the study group,4 cases of diverticulum polyps conformed as endometrial polyp.The removed scar diverticulum materials of the control group were indicated as fiber scar tissue by pathological examine.Among them,3 cases were diagnosed as scar diverticulum with endometrial polyp,and 1 case was with endometriosis.3.After 6 months of follow-up,the duration of postoperative menstrual period in both groups was shorter than the that of preoperative menstrual period.Among them,the study group was shortened from preoperative(14.05±3.44)to postoperative(5.80±2.04)d.The difference was statistically significant(t=10.22,P<0.001).In control group,the duration was shortened from preoperative.(14.29±3.24)to postoperative(6.41±2.00)d,the difference was statistically significant(t=10.69,P<0.001).The duration of menstrual period shortened more in the study group but there was no significantly differnece(t=-0.92,P=0.37).The improvement efficiency on postoperative menstrual in the study group(100%)was higher than that of the control group(94%),but the difference was not statistically significant(χ~2=1.56,P=0.46).4.The postoperative myometrial thickness of lower uterine segment was measured in two groups,The residual myometrium thickness were both increased after the surgery from(2.14±0.65)mm and(2.15±0.54)mm to(9.14±1.09)mm and(8.38±1.79)mm,in the study group and the control group,respectively.But the difference between the two groups was not statistically significant(t=1.58,P=0.12).5.Postoperative pregnancy follow-up: At present,there are only 5 patients who tried for pregnancy.There are 3 cases were in the study group.1 case is now 23 weeks pregnant with no obvious abnormality in the regular prenatal examination.1 case terminates the pregnancy due to abortion at 12 th week pregnancy,and is now in contraception.1 case is preparing for pregnancy.Other 2 cases are from the control group,1 of which is in early pregnancy while 1 case was preparing for pregnancy.Next,it is necessary to increase the sample size of patients with fertility requirements,follow-up pregnancy outcome and compare it between groups.Conclusion:Hysteroscopy combined with transvaginal folding suture and hysteroscopy combined with transvaginal incision suture are both effective on the treatment of cesarean scar diverticulum.Hysteroscopy combined with transvaginal folding suture has better clinical efficacy with shorter operative time,less intraoperative bleeding,preservation the integrity of the myometrium,shortening the time of postoperative contraception for older patients with urgent fertility requirements,which is worth clinical promotion.