RESUMO
Objective To investigate the significance of previous uterine scar excision during the second cesarean section on prevention of previous cesarean scar diverticulum (PCSD). Methods One hundred and seventy-eight cases of multipara women who underwent the second cesarean section were included from January 2012 to January 2017. And they were divided into the control group and the observation group by random digital table, with 89 cases in each group. In the control group, the uterine incision was directly closed by double-layer continuous suture without any treatment to the previous scar, and in the observation group, the previous uterine cesarean scar of the patients were removed, and then the uterine incision was closed by double-layer continuous suture. The surgical related indexes of the two groups were recorded and statistically analyzed. All patients were followed up for 1 year, and the abnormal vaginal bleeding, PCSD, the residual musculocutaneous thickness of diverticulum and the volume of diverticulum were statistically analyzed in those two groups. Results There were no statistical difference between observation group and control group in operation time, intraoperative blood loss, evacuation time, the duration of postoperation bloody lochia and hospitalization time (P>0.05). However, the abnormal vaginal bleeding [5.6% (5/89) vs. 14.6% (13/89)], the incidence of PCSD: 3.4%(3/89) vs. 12.4%(11/89), and the residual musculocutaneous thickness of diverticulum: (7.36 ± 1.66) mm vs. (4.86 ± 1.38) mm, and the volume of diverticulum: (0.37 ± 0.16) ml vs. (0.54 ± 0.15) ml in the observation group were decreased respectively, the differences were statistically significant (P<0.05). Conclusions Excision of previous uterine scar during the second cesarean section is more beneficial for uterine section healing. It will reduce the frequency of PCSD formation, and alleviate the severity of PCSD.
RESUMO
Objective To investigate the effects of uterine benign disease in perimenopausal women underwent simultaneous hysterectomy and bilateral salpingectomy on pelvic pseudocyst,ovarian function and symptoms of peri-menopausal period.Methods Nine hundred and ninety-three patients with benign uterine disease underwent hysterectomy of total or subtotal uterus were selected as our subjects,who hospitalized from Jan 2005 to Dec 2009.All patients were followed up for 36 months,and 235 patients were lost.The rest 758 patients included 438 patients underwent simultaneous hysterectomy and bilateral salpingectomy,who were served as study group,and 320 patients underwent only hysterectomy were served as control group.The occurrence of pelvic pseudocyst,symptoms of peri-menopausal period and the changes of serum sexual hormone were observed.Results (1) The rate of pelvic pseudocyst was 1.6％ (7/438) in study group,which was significantly lower than that in control group (4.4％ (14/320),x2 =10.962,P =0.026).(2) Follicle-stimulating hormone (FSH) in study group at 6 months and 12 months after surgery were (17.7 ±2.3) U/L and (26.8±5.1) U/L,higher than that in control group((12.3 ±2.9) U/L,(22.4 ± 3.2) U/L,t =-1.020,-1.162,P ＜ 0.05);FSH in study group(34.0 ± 6.8) U/L was lower than that in control group (39.1 ± 4.9) U/L at 36 months after surgery,and the difference was statistically significant (t =-1.209,P ＜ 0.05).At 3 months and 12 months after surgery,luteinizing hormone (LH) in study group were (14.0 ± 2.3) U/L and (26.2 ± 3.1) U/L,higher than that in control group ((11.7 ± 2.6) U/L,(21.6 ± 1.9) U/L; t =-1.421,-0.962,P ＜ 0.05).Estradiol in study group was (90 ± 23) pmol/L,lower than that in control group((110 ± 18) pmol/L) at 24 months after surgery(t =-1.502,P ＜0.05).(3) At 6 months after surgery,the rate of perimenopausl systems was 21.7％ (95/438) in study group,higher than that in control group (14.1％ (45/320),x2 =9.102,P =0.027).However,at 24 months after surgery,the rate of perimenopausal symptoms in control group was 60.6％ (194/320),higher than that in study group (47.0％ (206/438),x2 =7.620,P =0.039).Conclusion Simultaneous hysterectomy and bilateral salpingectomy could decrease the occurrence of pelvic pseudocyst and peri-menopausal symptoms nearly equivalent to that of hysterectomy only in patients with benign uterine diseases.