Study On The Prognosis Of Hysteroscopy Combined With Laparoscopic Repair Of Previous Cesarean Scar Defect

Objective:To evaluate the gynecological and obstetric outcomes of 58 patients after hysteroscopy combined with laparoscopy repair of previous cesarean scar defect.Methods:A retrospective stiicty included patients aged 23 to 36 years old who underwent hysteroscopy combined with laparoscopic repair of previous cesarean scar defect from July 2014 to March 2019 in our City’s Women and Children’s Hospital,by reviewing medical records and telephone calls,the general information of the patients,the postoperative pregnancy status of the surgical data and the related data of the delivery were collected.Finally,58 patients were included in the study.Main observation indicators:mainly observed preoperative and postoperative menstrual period and cycle;Dysmenorrhea,chronic pelvic pain,pain doling intercourse;Changes in the thickness of remaining muscle layer in uterine incision;Changes of previous cesarean scar effusion;Outcome of second pregnancy.Results:Preoperative menstrual period:13(10,22)A postoperative menstrual period:7(3,15)d,postoperative menstrual period was significantly shorter than the preoperative period,there are obvious differences(Z=-6.522,P=0.000<0.05).The menstrual cycle 30(23,37)d before surgery and 30(23,37)d after surgery,there was no significant change in the menstrual cycle before and after surgery(Z=1.342,P=0.180>0.05).Preoperative scar effusion:354(12,33880)mm3,postoperative scar effusion:0(0,880)mm3,the effusion in the postoperative scar was obviously reduced or even disappeared,there are obvious differennces(Z=-6.511,P=0.000<0.05).At the same time,symptoms of dysmenorrhea,chronic pelvic pain and pain during intercourse were compared with that before operation,it was relieved obviously and there are obvious differences(X2=7.849,P=0.005<0.05,X2=4.337,P=0.037<0,05,X2=4.453,P=0.035<0.05).Vaginal color altrawound was used to detect the residbual myometrum thickness of the uterine incision before the oparation:1.52±0.66mm,the residual myometrum thickness of the uterine incision after the operation was 437±1.21mm,the residuld myometrum thickness of the uterine incision after the operation was significantly increased compared with that before the surgery,and there are obvious differences(T=-16.800,P=0.000<0.05).Magnetic resonance imaging was used to detect the residual myometrum thickness of the uterine incision before the operation:1.88±0.70mm,the residual myometrum thickness of the uterine incision after the operation:5.80±137mm,the residual myometrum thickness of the uterine incision after the operation was significantly increased compared that before the surgery,and there are obvious differences(T=-20.125,P=0.000<0.05)In all histopathology,12 patients were fibrous tissue with endometriosis.The total pregnancy rate was 63.04%(34/46),and the full-termi delivery rate was 60.89%(26/46),gave birth to 4.35%(2/46)of preterm labor due to other obstetric reasons,all were delivered by cesarean section.Currently in the second trimester 10.87%(5/46),missed abortion 2.17%(1/46).There ware no cases of myometrium clefts during pregnancy(ultrasound evaluation)or during surgery in the current pregnancy and at the end of pregnancy.There was no scar pregnancy,no placental implantation,and 3 cases of postpartum hemorrhage.Conclusion:Hysteroscopy combined with laparoscopic repair of previous cesarean scar defect can effectively shorten the menstrual days,without affecting the menstrual cycle.The symptums of dysmenorrhea,chronic pelvic pain and the Sexual pain were improved.Increase the thicknes of the remaining myometrium of the uterine incision,reduce or even eliminate the effosion at the previous cesarean scar.The pathological results of the surgical specimens showed that some of them were fibrous tiusue with eadometriosis.The outcome of the pregnancy was good.Therefore,PCSD patients with prolonged menstrual period,the remaining myometrium of previous cesarean scar<3mm and there was a requirement for reproduction,hysteroscopy combined with laparoscopy repair of previous cesarean scar defectwas considered to be a safe and effective method and with good pregnancy outcome.