The Clinical Study Of Cesarean Section Diverticulum In61Cases

Objective:To study the risk factors and clinical features of Cesarean section diverticulum, and to investigate the surgical effort on the repair. Methods:The medical records of61patients with cesarean section diverticulum who underwent surgery in the Obstetrics and Gynecology Hospital of the Fudan University from February2011to November2012were retrospectively analyzed, including reproductive history.menstrual history, indication for cesarean section, clinical symptoms, assistant examination and treatment. Patients who received surgery were followed-up, to see the remission of the symptoms and the healing of the nick. All data were analyzed by SPSS18.0. Results:The mean age of61patients was33.5±3.8years(range27-43). The indication for cesarean section:social factors22cases, scar uterus20cases, cephalopelvic disproportion5cases, extend incubation3cases, pelvic presentation2cases, twins2cases, premature rupture of fetal membranes2cases, premature birth, gestation with fibroids and oligoamnios each1case. The main symptom was prolonged menstruation, form9-20days, mean14.5±3. ldays, of which,8cases together with high menstrual blood volume,2cases with pelvic pain and1with infertility.The symptoms appeared at the frist menses in29cases, however,in the other29cases, it appeared after a normal menstrual cycle, range form3months to9years, mean2.8±0.5years. Theres was no statistical significance between the depth and the muscular thickness of diverticulum with the symptoms.21cases received0C therapy before operation, in which,52.4%patients' symptom remitted, but the symptom recurred after drug withdrawal.17patients received endocevical curettage, among which.secretory endometrium in14cases, proliferative changes in3cases.58patients received hysteroscopy combined with laparoscopy, lpatient received laparotomy and one transvaginal surgery. The mean operation time was (130±47)min, the mean blood loss was (102±79ml)ml. There was no intra-operative complications. These cases were followed for an average of (13.7±5.5) months.32patients had an shortened period, and the duration was (3-10)days, mean (8.4±1.9)days, one patient successful pregnancy and childbirth after surgery?The surgical effective rate was54.1%(33/61), patient satisfaction rate was49.2%(30/61).61.2%patents could find a smaller scar diverticulum through transvaginal ultrasonography examination in3-12moths after surgery.Conclusion:Multipal cesarean section maybe the risk factor of scar diverticulum, the main clinical symptom was prolonged menstruation, could together with high menstrual blood volume, pelvic pain and infertility. There was no statistical significance between the depth and the muscular thickness of diverticulum through MRI examination with the symptoms. OC therapy had a success rate of52.4%, but high recurrence rate when suspend therapy. The surgical effective rate was54.1%(33/61), patient satisfaction rate was49.2%(30/61).61.2%patents could find a smaller scar diverticulum through transvaginal ultrasonography in3-12moths after surgery...