Analysis Of The Clinical Effect Of Endoscopic Surgery In The Treatment Of Cesarean Scar Diverticulum

Objectives: The study investigated the efficacy of two surgical methods in the treatment of cesarean scar defect(PCSD).Methods: Among 71 patients with PCSD enrolled in this study,36 patients with residual myometrium thickness(RMT)≥ 3 mm were treated using hysteroscopy(hysteroscopic group)and 35 patients with RMT < 3 mm were treated with laparoscopic surgery combined with hysteroscopy(hysteroscopy combined with laparoscopy group).The patients were followed up post-surgery to assess symptom improvement and pregnancy outcomes of infertility patients.The related factors affecting postoperative symptoms improvement in the two groups were screened out.Results:(1)Compared with the duration before treatment,the menstruation period was significantly reduced after operation in both groups(P < 0.05).(2)The effective rate of symptom improvement was 77.8%(28 / 36)in hysteroscopy group and 88.6%(31 / 35) in hysteroscopy combined with laparoscopy group.(3)Multivariate analysis suggested that the depth of diverticulum may be an independent risk factor affecting the efficacy of hysteroscopy surgery(P=0.029,OR=4.419,OR 95% CI [1.167,16.726])and hysteroscopy combined with laparoscopy surgery(P=0.034,OR=1.619,OR 95% CI[1.037,2.528]).The probability formula for predicting the ineffectiveness of symptom improvement after hysteroscopy surgery is P= 1/[1+exp(-7.067+1.486X2)],and the probability formula for predicting the ineffectiveness of symptom improvement after hysteroscopy combined with laparoscopy is P= 1/[1+exp(-5.782+0.482X3)].Receiver operating characteristic(ROC)curves were drawn respectively.Area under curve(AUC)of hysteroscopy group was 0.902,and its 95% confidence interval was [0.756,0.975];AUC of hysteroscopy combined with laparoscopy group was 0.875,and its 95%confidence interval was [0.719,0.962],indicating that the regression model is highly effective.(4)Hysteroscopic surgery and hysteroscopy combined with laparoscopy surgery can improve the pregnancy outcome of infertility patients to a certain extent.The postoperative pregnancy rates were 50.0%(3 / 6)and 66.7%(8 / 12),respectively.Conclusions:(1)For PCSD patients who want to improve symptoms and pregnancy outcome,the operation is decided by RMT,that is,hysteroscopic surgery is performed for RMT≥ 3mm,and laparoscopic surgery combined with hysteroscopy is performed for RMT< 3mm.Both groups can improve symptoms and pregnancy outcome to a certain extent,and operations accomplished smoothly in both groups,and there is no complication after operation.(2)Taking RMT = 3mm as the boundary,the operation method is safe and economically appropriate.(3)Diverticulum depth may be a risk factor for symptoms improvement in patients with PCSD after endoscopic surgery,which provides a basis for predicting the prognosis of surgery.Due to the small number of cases,it needs to expand the sample size to correct again.