Single-port laparoscopy-assisted vaginal repair of a cesarean scar defect: a single-center retrospective study

作     者：Yong-Li Zhang Guo-Cheng Wang Jun-Jie Qu Gui-Qiang Du Wei-Qiang Zhou Zhang Yong-Li;Wang Guo-Cheng;Qu Jun-Jie;Du Gui-Qiang;Zhou Wei-Qiang

作者机构：Department of Obstetrics and GynecologyShanghai First Maternity and Infant HospitalTongji University School of MedicineShanghai 201204China. 

出 版 物：《Chinese Medical Journal》 (中华医学杂志（英文版）)

年 卷 期：2020年第133卷第3期

页      面：285-291页

核心收录：

学科分类：1002[医学-临床医学] 100211[医学-妇产科学] 10[医学] 

基　　金：This study was supported by a grant from the Shanghai Pudong New Area Health and Family Planning Commission(No.PW2018D-13). 

主　　题：Single-port laparoscopy Uterine cesarean scar defect(niche) Adhesion 

摘      要：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.