磁共振成像在剖宫产术后子宫切口憩室中的评价应用及临床处理分析

Analysis of MRI applied in evaluation of previous cesarean scar defect and measure two different clinical treatments

摘要:

目的??探讨磁共振成像（MRI）在剖宫产术后子宫切口憩室（PCSD）中的评价应用及不同治疗方案的临床疗效。方法??对行MRI检查并手术治疗的128例PCSD患者的临床资料进行总结分析及术后随访，通过MRI完整评价PCSD，结合临床症状、生育要求等决定不同的手术治疗方案，对手术疗效、手术情况和治疗效果等进行评估。结果??①128例MRI检查提示憩室顶端残留肌层厚度≤2.00 mm有98例，>2.00 mm有30例；②符合条件的行宫腔镜手术26例，宫腹腔镜手术102例，宫腔镜手术时间、术中出血量、术后住院时间及住院费用均低于宫腹腔镜手术，差异均有统计学意义（均P <0.05）；③两种手术治疗的症状学评估总有效率分别为88.5%（23/26），93.8%（75/80），差异无统计学意义（P =0.770）；④宫腹腔镜下憩室切除修补术的解剖学评估手术有效率为97.1%（99/102）；手术前后憩室顶端残留肌层厚度均明显增厚，差异有统计学意义（P <0.01）；⑤随访成功妊娠34例，足月分娩24例，其中经阴道分娩者有6例，PCSD妊娠6例。结论??①MRI检查是全面评价PCSD的可靠方法；②宫腔镜及宫腹腔镜手术均是有效治疗手段，但各有优势，临床上可根据患者的病情综合考虑制定相应的手术治疗方案；③宫腹腔镜下修补术对憩室的解剖结构异常具有较好的改善作用，值得推广使用的。

Abstract:

Objective?To explore the application of MRI in the evaluation of previous cesarean scar defect (PCSD) and the clinical efficacy of different treatments of PCSD.?Methods?128 PCSD patients’ MRI examination were performed and received surgical treatments latter. Theirs clinical data were reviewed retrospectively and followed-up. The surgical treatment was decided completely by MRI evaluation of PCSD, clinical symptoms and fertility requirements.?Results?The thickness of diverticulum was measured by MRI. The number which thickness of less than 2.00 mm is 98 cases, no less than 2.00 mm is 30 cases. 26 cases were used hysteroscopy diverticulum incision, 102 cases were treated by hysteroscopy combined with laparoscopy diverticulectomy repair. The operation time, the amount of bleeding, postoperative hospital stay and hospital costs of hysteroscopy were lower than the rate of hysteroscopy combined with laparoscopy surgery, the difference was statistically significant (P < 0.05). The total operation effective rate of assess the clinic symptoms were 88.5 % (23/26) and 93.8 % (75/80), the difference was not statistically significant (P = 0.770). The operation effective rate of hysteroscopy combined with laparoscopy surgery was 97.1 ％ (99/102) for anatomic assessment. The distance of the PCSD from the residual muscle became thicker after surgery significantly (P < 0.01). There were 34 patients who successful pregnancy and 24 cases delivered in term including 6 cases of vaginal delivery. 6 cases of patients were uterine incision diverticulum of pregnancy after cesarean section.?Conclusions?MRI is a reliable method for comprehensive evaluation of PCSD. Hysteroscopy diverticulum incision and hysteroscopy combined with laparoscopy diverticulectomy repair are effective treatment for PCSD, The corresponding treatment plan can be made according to the patient’S condition. Hysteroscopy combined with laparoscopy diverticulectomy repair has better effect in improving anatomical structure of diverticulum. It is worth to be popularized in the treatment of patients with PCSD.