The Analyze Of The Efficacy Of The Three Operation Method In Treating Patients With Uterine Incision Diverticulum

BackgroudIn recent years, with the cesarean section rate gradually increasing, the incidenceof previous cesarean scar defect (PCSD) has increased as well. Uterine scar defect hasbecome a common complication of cesarean section. The main complaints areprolonged bleeding, irregular bleeding and infertility. A small number of patientshave the lumbosacral soreness before or after menstruation, dysmenorrheal andchronic lower abdominal pain. The women have a risk of hysterorrhexis during themid to late gestation and childbirth. The uterine scar defect pregnancy may lead toheavy bleeding, hemorrhagic shock, hypopituitarism and can have life-threateningcomplications. With the high improvement of heath knowledge and treatmenttechnology, the positive PSCD rate has increased remarkably. How to improve thetherapy compliance has become a hot problem. At present, the methods to PSCD areconservative treatment and supplementary operation. Oral hormonal drugs are themain methods in conservative treatment. The surgical treatments are transvaginaloperation, open surgery, hysteroscopic operation, laparoscopic surgery andhysteroscopy combined with laparoscopy. There are different treatments depended onsurgeries in the literature.The first affiliated hospital of Zhengzhou university hasbeen exploring and improving the treatment of the disease, the paper discusses theeffect and deficiency of the common three kinds of surgeries in our hospital in recentyears. ObjectiveTo compare and analyze the clinical effects through the ways of hysteroscope,vaginal operation or hysteroscopy combined with laparoscopy.In order to look for amost economical, safe and effective surgical treatment to the uterine incisiondiverticulum after cesarean section patients who had failed in conservative treatment.Materials and methods1MaterialsIn this study, we collected71patients who had previous cesarean scar defectfrom Feb2008to May2012in the first affiliated hospital of Zhengzhou university,38cases were performed hysteroscopic combined with laparoscopic surgery,20patients underwent vaginal surgery and others13cases had hysteroscopic operation.2MethodsCarries on the review analysis to the material of the patients, all patients werefollowed for two years to compare the mode of operation and post-operationrecovery.3StatisticsSPSS18.0statistical software for statistical analysis, use Student’s t test andAnalysis of variance to compare the measurement data, such as age, times ofgestation and parity, time interval of the last cesarean section to the onset, the modeof operation, vaginal bleeding and abdominal pain, infertility,etc. Chi-square test isused to compare numeration date, such as amount of bleeding, the time ofexsufflation through anus,, the cure rate, the operation time, days of hospital stay, thetime of vaginal bleeding, the costs, and the pregnancy rate, etc. P<0.05withstatistically significant.Results1. There is no significantly different of age, parity, time interval of the last cesareansection to the onset, the mode of operation, vaginal irregular bleeding, dysmenorrheaand infertility(P>0.05) among the three groups, comparable.2. The amount of bleeding, time of vaginal bleeding after operation,hospital stay andhospitalization costs of the three groups were compared, the difference wasstatistically significant (P <0.05). 3. The time of anal exsufflation, the pregnancy rate, difference of three set of patientshad no statistics significance (P>0.05).4. The menstrual cycle status depended on the time after operation, the recovery ofmenstrual cycle were significantly different (P<0.05) in the three group, thedifference of the efficient rate between hysteroscopy group and vaginal operationwere statistically significant(P>0.05),but the two group were all had statisticallysignificant between the hysteroscopy group in the difference of the efficientrate.(P<0.05)Conclusion1. For the treatment of PCSD,Hysteroscopic surgery has less trauma and quickerrecovery advantages, compared with vaginal operation and hysteroscopy combinedwith laparoscopy. When it comes to the efficiency and the menstrual condition,hysteroscopic surgery is not as good as the other two treatment methods. The time ofoperation and hospitalization costs of vaginal group are obviously lower than theother two groups, but it prolongs hospital stay and the time of vaginal bleeding afteroperation and has a higher infection rate. Hysteroscopy combined with laparoscopyoperation has less trauma, good effect, and can be on combination therapy, but thehigh costs and technical demanding are critical factor2. All the three methods are effective, with the characteristic respectively. Ourclinicians should know the indications and contraindications of the different methods.Different measures should be given to different patients according to the patients’situations, bearing requirement, previous pelvic infection history, and economicconditions to find a safe, efficient and economic method.