〔摘 要〕 目的：探讨宫腔镜子宫瘢痕憩室电切术、宫腹腔镜联合子宫瘢痕憩室折叠缝合修补术及左炔诺孕酮宫内缓系 统（LNG–IUS）治疗剖宫产术后子宫瘢痕憩室（CSD）所致经期延长的疗效。 方法：选取 2018 年 1 月至 2022 年 1 月在厦 门大学附属第一医院诊治的 105 例 CSD 所致经期延长患者，根据不同的治疗方式分为 47 例宫腔镜子宫瘢痕憩室电切术组 （宫腔镜组），35 例宫腹腔镜联合子宫瘢痕憩室折叠缝合修补术组（宫腹腔镜组），23 例 LNG–IUS 治疗组（LNG–IUS 组）， 比较三组患者治疗后月经改善情况及治疗有效率。 结果：治疗后 12 个月，LNG–IUS 组患者经期持续时间短于宫腔镜组、 宫腹腔镜组，差异具有统计学意义（P ＜ 0.05）；宫腔镜组患者手术时间、住院天数短于宫腹腔镜组，术中出血量、住院 费用少于宫腹腔镜组，差异具有统计学意义（P ＜ 0.05）；LNG–IUS 组患者直接医疗费用低于宫腔镜组、宫腹腔镜组，差 异具有统计学意义（P ＜ 0.05）。 结论：三种方式均能有效改善 CSD 所致经期延长症状，LNG–IUS 治疗简单、经济、安全， 可作为无生育需求患者的优先治疗方式。
〔Abstract〕 Objective To investigate the effect of hysteroscopic electroresection of uterine scar diverticulum, hysteroscopiclaparoscopic combined with folding and suture repair of uterine scar diverticulum and levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of prolonged menstrual period caused by cesarean scar diverticulum (CSD) after cesarean section. Methods A total of 105 patients with prolonged menstrual period due to CSD diagnosed and treated in the First Affiliated Hospital of Xiamen University from January 2018 to January 2022. According to different treatment methods, they were divided into 47 cases with hysteroscopic electric resection of uterine scar diverticulum (hysteroscopic group) , 35 cases with hysteroscopic-laparoscopic combined with folding and suture repair of uterine scar diverticulum (hysteroscopic-laparoscopic group) and 23 cases of LNG-IUS treatment group (LNG-IUS group). The menstrual improvement and treatment efficiency of the three groups of patients were compared after treatment. Results 12 months after treatment, the duration of menstrual period in LNG-IUS group was shorter than that in the hysteroscopic group and the hysteroscopic-laparoscopic group, and the differences were statistically significant (P < 0.05). The operation time and hospitalization days in the hysteroscopic group were shorter than those in the hysteroscopiclaparoscopic group, and the intraoperative blood loss and hospitalization cost were less than those in the hysteroscopic-laparoscopic group, with statistical significance (P < 0.05). The direct medical cost of LNG-IUS group was lower than those of the hysteroscopic group and the hysteroscopic-laparoscopic group, and the differences were statistically significant (P < 0.05). Conclusion The three methods can effectively improve the symptoms of prolonged menstrual period caused by CSD. LNG-IUS treatment is simple, economical and safe, and can be used as the priority selection for patients with no fertility needs.