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目的探讨剖宫产术后子宫切口憩室的临床诊治措施。方法对9例剖宫产术后子宫切口憩室的临床特点和诊疗方法进行分析。结果 9例剖宫产术后子宫切口憩室患者,发病年龄:28~37岁,平均年龄(30.7±2.3)岁,剖宫产术前月经均规律,经期4~7 d,否认有痛经史。发病时间:1例症状出现时间术后恢复月经1~6个月,5例术后恢复月经6个月~2年,3例术后恢复月经2年后。前次剖宫产情况:3例未临产行剖宫产,6例患者是产程中宫口开大后再行剖宫产。9例患者就诊主诉多为异常子宫出血,如经期延长或阴道不规则出血;月经周期规律,经量正常,月经前7 d与剖宫产术前无明显差异,之后出现咖啡色分泌物淋漓不尽,经期持续时间10~23 d,平均持续(13.1±3.4)d;下腹部坠胀;痛经。妇科检查:阴道少量暗红色血液,宫口闭,子宫、附件未及包块,排除宫颈及内膜等病变引起的异常子宫出血。根据患者有剖宫产史,结合B超等检查可诊断子宫切口憩室。9例患者单纯给予止血治疗效果不佳情况下,在无生育要求、无避孕药禁忌情况下改用口服避孕药治疗,治疗3~6个月可缓解症状,停药后复发。大多数患者因药物不良反应不愿长期接受治疗,依从性差。目前常规的手术治疗方法主要是宫腔镜术、宫腔镜联合腹腔镜手术、阴道手术等。结论减少剖宫产术后子宫切口憩室的发生,应严格把握剖宫产的手术指征。剖宫产术后常规行阴道超声检查子宫切口情况,对于早期发现子宫切口憩室具有重要的临床价值。
Objective To investigate the clinical diagnosis and treatment of uterine incision diverticulum after cesarean section. Methods Nine cases of cesarean section after uterine incision diverticulum clinical features and diagnosis and treatment methods were analyzed. Results 9 cases of cesarean section after uterine incision diverticulum patients, age of onset: 28 to 37 years old, mean age (30.7 ± 2.3) years of age, cesarean section before menstruation regular menstruation 4 to 7 days, denied a history of dysmenorrhea. Time of onset: 1 case of symptoms recovered after menstruation 1 to 6 months, 5 cases of postoperative menstruation 6 months to 2 years, 3 cases recovered 2 months after surgery. Cesarean section last case: 3 cases of non-labor cesarean section, 6 cases of labor is in the labor after the cervix open cesarean section. Nine patients were complained of abnormal uterine bleeding, such as menstrual prolongation or vaginal irregular bleeding; menstrual cycle, normal menstruation, 7d before menstruation and no significant difference before cesarean section, followed by the disappearance of brown secretions , Duration of menstruation was 10 ~ 23 days, with an average of (13.1 ± 3.4) d; bulge in lower abdomen; dysmenorrhea. Gynecological examination: a small amount of vaginal dark red blood, cervix closed, uterus, annex and mass, excluding cervical and endometrial lesions caused by abnormal uterine bleeding. According to the history of patients with cesarean section, combined with B ultrasound examination can diagnose the uterine incision diverticulum. Nine patients were treated with oral contraceptives without fertility and no contraceptive contraindications. The treatment of 3 to 6 months could relieve the symptoms and relapse after drug withdrawal. Most patients do not want long-term treatment due to adverse drug reactions, poor compliance. The current routine surgical treatment is mainly hysteroscopy, hysteroscopy combined laparoscopic surgery, vaginal surgery. Conclusions To reduce the occurrence of uterine incision diverticulum after cesarean section, surgical indication of cesarean section should be strictly controlled. Cesarean routine routine vaginal ultrasound examination of uterine incision for early detection of uterine incision diverticulum has important clinical value.