宫腹腔镜联合治疗有生育需求子宫瘢痕憩室的疗效研究

Efficacy of combined hysteroscopy and laparoscopy for cesarean section scar diverticulum in women seeking fertility treatment

摘要:

目的 探究宫腹腔镜联合治疗有生育需求子宫瘢痕憩室的疗效。方法 回顾性分析2021年9月—2024年2月徐州市妇幼保健院收治的92例子宫瘢痕憩室患者的病历资料，按照治疗方法分为观察组50例和对照组42例。对照组采用宫腔镜治疗方案，观察组采用宫腹腔镜联合治疗方案。比较两组的手术指标、术后子宫前壁下段肌层厚度、术后宫颈管黏液炎症因子、疗效及并发症，术后随访1年，记录患者的妊娠率。结果 观察组手术时间、术中出血量、术后阴道流血时间及住院时间均大于对照组（P <0.05）。观察组手术前后子宫前壁肌层厚度的差值大于对照组（P <0.05）。两组术后白细胞介素-2、肿瘤坏死因子-α和pH值均低于术前（P <0.05）。观察组总有效率高于对照组（P <0.05）。两组术后总不良反应发生率比较，差异无统计学意义（P >0.05）。观察组术后成功妊娠率高于对照组（P <0.05）。两组妊娠后的流产率比较，差异无统计学意义（P >0.05）。结论 宫腹腔镜联合治疗子宫瘢痕憩室，有助于提高治疗有效率及术后妊娠率，但可能延长手术时间。

Abstract:

Objective To investigate the efficacy of combined hysteroscopy and laparoscopy for cesarean section scar diverticulum in women seeking fertility treatment.Methods A retrospective analysis was conducted on the medical records of 92 patients with cesarean section scar diverticulum admitted to Xuzhou Maternity and Child Healthcare Hospital from September 2021 to February 2024. Patients were divided into an observation group (50 cases) and a control group (42 cases) based on the treatment methods. Patients in the control group were treated with hysteroscopy alone, whereas those in the observation group received a combination of hysteroscopy and laparoscopy. The surgical indicators, postoperative thickness of the anterior lower uterine wall myometrium, postoperative cervical mucus inflammatory markers, treatment efficacy, and complications were compared between the two groups. Patients were followed for 1 year after surgery, and pregnancy rates were recorded.Results The observation group had longer operative duration, greater intraoperative blood loss, and longer postoperative vaginal bleeding duration and length of hospital stay than in the control group (P < 0.05). The change in anterior uterine wall myometrial thickness from pre- to post-surgery was greater in the observation group compared with the control group (P < 0.05). Postoperatively, levels of interleukin-2 (IL-2), tumor necrosis factor-α (TNF-α), and pH values decreased in both groups compared with preoperative values (P < 0.05). The overall treatment efficacy was higher in the observation group than in the control group (P < 0.05). There was no significant difference in the overall incidence of adverse reactions between the two groups (P > 0.05). The postoperative pregnancy rate was higher in the observation group than in the control group (P < 0.05), while no significant difference was observed in the miscarriage rate between the two groups (P > 0.05).Conclusion Combined hysteroscopy and laparoscopy for cesarean section scar diverticulum improves treatment efficacy and postoperative pregnancy rates, but may prolong the operative duration.