Comparison of two surgical approaches to uterine scar diverticulum through natural orifices
NING Jing1, LI Yan1, YANG Yang2
1. Department of Obstetrics and Gynecology,Hainan Hospital of PLA General Hospital,Sanya 572013,China; 2. Department of Liver Transplantation,the Third Medical Center of PLA General Hospital,Beijing 100039,China
Abstract：Objective To explore the efficacy and clinical applicability of two surgical approaches to uterine scar diverticulum (hysteroscopy and transvaginal uterine scar diverticulum resection) through natural orifices.Methods A total of 84 patients with prolonged menstrual periods after cesarean section admitted between June 2016 and June 2019 were confirmed to be cases of uterine scar diverticulum by B ultrasound and hysteroscopy examination.Thirty-one of them were treated with hysteroscopic resection,and the rest with transvaginal uterine scar diverticulum resection.Resluts The total effective rate was 87.1% in the hysteroscopy group and 86.8% in the transvaginal surgery group three months after operation.The average duration of surgery in the hysteroscopy group and transvaginal surgery group was (19.3±6.1)min and (33.3±7.1)min,respectively.The mean volume of intraoperative blood loss was (11.5±3.7)ml in the hysteroscopy group and (48.2±10.7)ml in the transvaginal surgery group,respectively.The postoperative pain scores of the hysteroscopy group and transvaginal group were(1.3±0.9) and (3.3±1.1) respectively.Hospitalization expenses were(4817±386)and(11071±1041) yuan,and postoperative hospital stay was(1.4±0.7) days and (3.2±0.8)days,respectively.There was no significant difference in the therapeutic effect between the two approaches.Conclusions The two surgical approaches to uterine scar diverticulum through natural orifices can both achieve satisfactory clinical outcomes,but hysteroscopic resection involves less bleeding,shorter duration of surgery and hospital stay,and lower expenses than transvaginal surgery,so it is suitable for extensive clinical application in the treatment of uterine scar diverticulum.
宁静, 李艳, 杨洋. 剖宫产子宫瘢痕憩室两种自然腔道手术的疗效比较[J]. 武警医学, 2020, 31(11): 952-954.
NING Jing, LI Yan, YANG Yang. Comparison of two surgical approaches to uterine scar diverticulum through natural orifices. Med. J. Chin. Peop. Armed Poli. Forc., 2020, 31(11): 952-954.
Suneet P C,Everett F M,Christopher D W.Pregnancy after classic cesarean delivery[J].Obstet Gynecol,2002,100(5):946-950.
[3]
Thurmond A S,Harvey W J,Smith S A,et al.Cesarean section scar as a cause of abnormal vaginal bleeding:diagnosis by sonohysterography[J].J Ultrasound Med,1999,18(1):13-16.
Bij A J,Voet L F,Naji O A.Prevalence,potential risk factors for development and symptoms related to the presence of uterine niches following cesarean section:systematic review[J].Ultrasound Obstet Gynecol,2014,43(4): 372-382.
[6]
Cecilia F,Pablo A,Carlos F.Surgical treatment and follow-up of women with intermenstrual bleeding due to cesarean section scar defect[J].J Minim Invasive Gynecol,2005,12(1):25-28.
2020, Vol. 31 
