ABSTRACT
Objective To investigate the clinical value of hysteroscopy and combined laparoscopic surgery in the treatment of previous cesarean scar diverticulum (PCSD).Methods 36 cases of PCSD in our hospital from January 2013 to January 2015 were selected.Among them,13 cases were treated with hysteroscopy diverticulum incision (hysteroscopic surgery group),and 23 cases underwent hysteroscopy combined with laparoscopy diverticulectomy repair (combined operation group).The diagnosis and surgical treatment of PCSD patients were recorded and the pregnancy outcome was followed up.Results The operation time [(39.5 ± 17.1) min vs (92.3 ± 30.8) min],the amount of bleeding [(18.2 ± 5.6) ml vs (98.6 ± 24.4) ml] and the length of hospital stay [(2.3 ± 0.6) days vs (5.2 ± 1.1) days] in hysteroscopic surgery group were less than those of hysteroscopy combined with laparoscopy (P ＜ 0.05).The time of vaginal bleeding after operation [(6.3 ± 1.7) days vs (13.4 ± 2.7) days] & [(6.9 ± 2.2) days vs (14.0 ± 3.1) days] was significandy less than that before operation in two operation methods (P ＜ 0.05).8 cases effective,1 cases partially effective,3 cases invalid were in the hysteroscopy group,while 16 cases effective,5 cases partially effective,2 cases invalid were in the combined operation group.The difference of curative effect between the two surgical methods was not statistically significant (P ＞0.05).17 cases of fertility requiring patients underwent hysteroscopy combined with laparoscopy diverticulectomy repair,of which 8 eases were successfully delivered after operation.Conclusions Individualized clinical decision-making should be made for PCSD patients.Hysteroscopy and combined hysteroperitoneal surgery have the same effect,but the latter should be chosen for those with severe clinical symptoms or reproductive needs.
ABSTRACT
Objective To explore the clinical efficacy and safety of loop suture ligation and arterial embolization in the treatment of postpartum hemorrhage caused by placenta placenta.Methods A total of 108 cases of cesarean section was divided with digital random method into control and study groups with 54 cases in each group.The patients in the control group were given the ring suture in the lower part of the uterus.The changes of blood pressure,pulse,and blood oxygen saturation before and after operation were compared.The clinical efficacy and safety were evaluated between two groups.Results Pressure,diastolic blood pressure,pulse and blood oxygen saturation of two groups were stable before and after contraction,the difference with two group before and after operation were not statistically significant (P ＞ 0.05),and two groups after operation during the same period,the difference was not statistically significant (P ＞ 0.05).Cesarean section bleeding in the control group [(2 134.75 ± 189.63)ml] was higher than the study group [(1 864.82 ± 201.33)ml] (P ＜ 0.05),and Apgar score at 1 min and hysterectomy rate differences were not statistically significant between two groups (P ＞ 0.05).The control group 24 h postoperative bleeding [(306.75 ± 151.33)ml] was higher than the study group [(249.34 ± 160.28)ml] (P ＜0.05),and two groups of postoperative antibiotic use time differences were not statistically significant (P ＞ 0.05).Hospitalization expenses control group [(3.06 ± 1.27) ten thousand yuan] were lower than the study group [(3.62 ± 1.35)ten thousand yuan] (P ＜0.05).Shock rate was 31.5％ in the control group,and study group 24.1％.The incidence rate of disseminated intravascular coagulation (DIC) was 14.8％ in the control group,and study group 11.1％.Postoperative fever incidence rate was 44.4％ in the control group,and study group 42.6％.Incidence of postoperative infection was 24.1％ in control group,and study group 18.5％.Shock rate,DIC rate,and postoperative fever incidence were not significant difference between two groups (P ＞ 0.05).Conclusions The cesarean section in the lower uterine segment circumsuture and arterial embolization treatment of postpartum hemorrhage had clinical curative effect,safe and reliable.The arterial embolization mosaic can effectively reduce the cesarean section bleeding and postoperative bleeding 24 h,while the lower uterine segment circumsuture was more economical.