Résumé
BACKGROUND@#The incidence of uterine cesarean scar defect (niche) is high, and some patients require surgery. Single-port laparoscopy can reduce post-operative pain, and provide better cosmetic effects. This study was performed to evaluate the safety and superiority of single-port laparoscopy-assisted vaginal repair of uterine cesarean scar defect (niche) in women after cesarean section.@*METHODS@#This study included 74 patients who were diagnosed with uterine cesarean niche at the Shanghai First Maternity and Infant Hospital from January 2013 to June 2015. Thirty-seven patients underwent single-port laparoscopy-assisted vaginal surgery as the case group, and the remaining patients underwent vaginal repair surgery as the control group. We collected data from the inpatient and follow-up medical records. The clinical characteristics of these two groups were compared. The odds ratios and 95% confidential intervals were calculated for each variable by univariate and multivariate analyses.@*RESULTS@#Patients who underwent single-port laparoscopy-assisted vaginal repair had a significantly longer operation time (2.3 [2.0-2.7] vs. 2.0 [1.6-2.3] h, P = 0.015), shorter gas passage time (1.2 [1.0-1.5] vs. 1.7 [1.0-2.0] days, P = 0.012), shorter hospital stay (3.1 [3.0-4.0] vs. 4.5 [4.0-6.0] days, P = 0.019), and fewer complications (0 vs. 4 cases). Univariate analysis showed that depth of the niche (P = 0.021) the mild adhesiolysis score (P = 0.035) and moderate adhesiolysis score (P = 0.013) were associated with the bladder injury. Multivariate analysis showed that the moderate adhesiolysis score (P = 0.029; 95% confidence interval, 1.318-3.526) was the strongest independent predictor of bladder injury.@*CONCLUSION@#This study confirmed the safety and superiority of single-port laparoscopy-assisted vaginal repair of uterine cesarean scars.
Résumé
<p><b>OBJECTIVE</b>To discuss the treatment and mechanisim of acetabulum fracture combined with ipsilateral lower extremity fracture.</p><p><b>METHODS</b>Fourteen cases(9 males and 5 females) of acetabulum fracture were involved in the study with the mean age of 35 years (range, from 18 to 65 years). According to Letournel classification, 11 cases were the fracture of posterior wall and column, 3 cases were only the fracture of posterior column. All of them were treated with titanium plate internal fixation. Of three cases with ipsilateral femoral intertrochanteric fracture, one was treated with external fixiation device, other two were treated with DHS fixation; Three cases with ipsilateral femoral neck fracture were treated with compressive cannulated screw fixation; Among six cases with ipsilateral femoral shaft fracture,one was fixed with steel plate,the rest underwent intramedullary nailing fixation; Two cases with ipsilateral tibial plateau fracture were treated with anatomic plate internal fixation.</p><p><b>RESULTS</b>All patients except the died old patient were followed up from 18 months to 5 years, with mean of 30 months. According to standard of American institute of orthopaedics, 9 cases obtained excellent results, 3 good and 2 poor and the excellent and good rate was 92.3%.</p><p><b>CONCLUSION</b>Most cases of acetabulum fracture combined with ipsilateral lower extremity fracture are due to great violence, their mechanisms are complex, and easily lead to missed diagnosis, therefore the early correct diagnosis, and reasonable internal fixation should be considered.</p>