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Objective To investigate the effects of hysteroscopic resection for mild-to-moderate uterine incision diverticulum after cesarean section.Methods From September 2010 to September 2014, hysteroscopic resection was performed under B-ultrasonography in 102 cases of mild-to-moderate uterine incision diverticulum after cesarean section.Results The operation was completed successfully in all the cases, without surgical complications.Outcome evaluation at 1 year after surgery showed cured in 89 cases (87.3%, complete disappearance of symptoms and recovery of normal menstruation), improved in 7 cases (6.9%, menstrual period shortened by 5-7 d, with or without lower abdominal dull pain and menstrual exacerbation), and ineffective in 6 cases (5.9%, no or slight symptom improvement).Conclusion Hysteroscopic resection is a safe, effective, and minimally invasive method for mild-to-moderate uterine incision diverticulum after cesarean section in patients demanding clinical symptom improvement without desire of fertility.
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Objective To explore the diagnostic value of transvaginal three-dimensional ultrasound in uterus abnormal bleeding caused by uterine incision diverticulum after cesarean section. Methods We collected 480 cases with cesarean section patients from January 2011 to July 2015 in our hospital. A retrospective analysis of the cases was performed by transvaginal ultrasound , if the incision diverticulum was found , for measuring and recording the depth , length , width and assessing the residual muscle layer thickness and the shape and volume of the diverticulum with vaginal bleeding in the following up. Results 118 cases were found incision diverticu-lum by ultrasound in 480 patients , including 70 cases of triangular , 33 cases of semicircle , 15 cases of other shapes , of which 56 patients of uterine abnormal bleeding were significantly correlated with the volume and depth of the diverticulum. While menstruation PBAC scores were higher , the greater probability associated with abnormal uterine bleeding , but bleeding did not associate with the shape and length and width of diverticula; In this study we also found that OR value (OR = 15.809) of the diverticulum volume maximum was the key factors leading to the abnormal uterine bleeding in uterine incision diverticulum. Conclusion Transvaginal three-dimen-sional ultrasound can be convenient , fast and accurate diagnosis of uterine abnormal bleeding caused by incision diverticulum , and is of important significance for guiding clinical medication and surgical treatment.
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Objective To investigate the clinical efficacy of uterine incision diverticulum type repair after cesarean section treated by laparoscopy and transvaginal combined with repair in.order to provide the reference for the clinical operation scheme selection.Methods Fifty-two patients who underwent uterine incision diverticulum type repair after cesarean section in the Second People's Hospital of Jingzhou were randomly divided into observation group and control group with 26 cases in each.Patients in the observation group were treated with laparoscopy combined with repair treatment,and patients in the control group were treated with transvaginal repair treatment.The operation periods,cut bleeding volume,postoperative anal exhaust time for the first time,postoperative highest temperature and length of hospital stay were recorded to evaluate the repair and uterine diverticula recovery at 3 months after operation.Results The operation periods in the observation group was (119.91 ± 35.73) min,longer than that in the control group ((62.32 ± 31.83) min ; t =3.514,P ＜0.05).There were on significant differences between two groups in terms of the amount of bleeding,anal discharge first time,the highest postoperative temperature and contrast after a few days in hospital (P＞ 0.05).After treatment,the observation group menstrual recovery rate was 84.62％ and 88.46％ in the control group.The differences were not statistically significant (x2 =1.14,1.76,P ＞ 0.05).Conclusion Laparoscopy hemiorrhaphy and transvaginal repair are effective treatment for uterine incision diverticulum after caesarean operation.The corresponding treatment plan can be made according to the patient's condition.
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Objective To investigate the diagnostic value of hysteroscopy combined with B -ultrasonography for uterine incision diverticulum after secondary cesarean section . Methods From May 2012 to May 2013, hysteroscopy check was performed in 38 cases with a history of two times of caesarean sections . The hysteroscopic results and ultrasound images were analyzed retrospectively . Results Incision diverticulum was diagnosed in 34 cases by using diagnostic hysteroscopy combined with B-ultrasonography, with a diagnosis rate of 89.5%(34/38).There were 18 cases of mild diverticulum (47.4%), 16 cases of severe diverticulum (42.1%), and 4 cases of good healing (10.5%).Of the 16 cases of severe diverticulum , the distance from top to serosal surface was 1.6-6.0 mm, and the width was 3-17 mm.Preoperative transvaginal ultrasonography ( TVS) showed only 10 cases of uterine incision diverticulum in patients with severe diverticulum , providing a diagnosis rate of 26.3% (10/38).Compared TVS with hysteroscopy combined with B-ultrasonography , there was a significant difference (χ2 =31.091, P=0.000) in the diagnosis rate for uterine incision diverticulum . Conclusion Hysteroscopy combined with B-ultrasonography has a high diagnosis rate for the diagnosis of uterine incision diverticulum in patients with two times of cesarean sections , being worthy of clinical application as a minimally invasive examination method after cesarean sections .
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Objective To observe the therapeutic effect of transvaginal repair of uterine diverticula after cesarean section.Methods The clinical data of 12 patients underwent transvaginal repair (group A) with uterine incision diverticulum treatment were retrospectively analyzed.13 cases underwent transabdominal repair of the uterine incision diverticulum were selected as group B.The operation time,intraoperative bleeding volume,postoperative exhaust time,hospital stay and the next days of menstrual period were compared between the two groups.Results In group A,the operation time was 48 min,the amount of bleeding was 30 ml,postoperative exhaust time was 9 h,the length of hospital stay was 4.5 d,the next time menstruation was 3-5 days,Those of group B were 120 min,120 ml,16 h,7.8 d and 3-5 d.The differences of operation time,bleeding volume,postoperative exhaust time,hospitalization days between the two groups were significant(P ＜ 0.05).There was no statistically significant difference between the two groups in the days of the next menstrual period (P ＞ 0.05).Conclusion The effect of transvaginal,transabdominal repair on uterine diverticula formation after cesarean section is clear,but the transvaginal operation can shorten the operation time,reduce intraoperative bleeding volume,shorten postoperative exhaust time and decrease the hospitalization days,thus reduce the cost of hospitalization.