摘要
目的对比分析外生型剖宫产瘢痕妊娠（CSP）两种治疗方法的临床疗效。方法回顾性分析2011年1月至2016年1月68例外生型CSP患者的临床资料。按不同手术方式分为子宫动脉化疗栓塞术（UAE）联合宫腔镜下病灶切除术组（宫腔镜组）18例和UAE联合腹腔镜下妊娠病灶切除术组（腹腔镜纽）50例。观察两纽患者术中出血量、手术时间、血清人绒毛膜促性腺激素（β—HCG）下降至正常时间、病灶吸收时间、术后月经恢复时间等情况。结果宫腔镜组中3例因病灶外凸明显，术中出血量大转行腹腔镜病灶切除术，2例因术后肌层妊娠处残留病灶行二次宫腔镜手术，另外12例均顺利完成手术，腹腔镜组41例手术均顺利完成。宫腔镜组手术时间低于腹腔镜组，血清β-HCG下降至正常时间长于腹腔镜组，差异有统计学意义（P〈0．05），两组术中出血量、术后月经恢复时间比较差异未见统计学意义（P〉0．05）；病灶吸收时间宫腔镜组为（41±4）d，腹腔镜组因病灶已经完全剔除，故不涉及病灶吸收时间。结论两种手术方式均可用于治疗外生型CSP，但对于病灶外凸明显、瘢痕处组织厚度菲薄患者经腹腔镜手术的安全性和可行性优于宫腔镜组。
Objective To compare and analyze the clinical curative effects of two methods on exogenous cesarean scar pregnancy（CSP）. Methods From January 2011 to January 2016, the clinical data of 68 patients with CSP were studied retrospectively, they were divided into two groups： 17 cases were treated by uterine artery embolization combined with hysteroscopic surgery （hysteroscopic group） ; 41 cases were treated by uterine artery embolization combined with laparoscopic surgery （laparoscopic group）. The bleeding and operation time, blood β-HCG decreased to normal time, postoperative recovery time of menstrual were observed between the two groups. Results Three cases in the hysteroscopic group were transformed to laparoscopic surgery because of introperative bloody loss, and two cases underwent second hysteroscopic surgery due to the ultrasound examination indicating a mass located in the ce- sarean scar, the 12 cases underwent hysteroscopic surgery successfully. Laparoscopic surgery were successfully completed in all of the 41 cases. In the hysteroscopic group, the operation time was shorter than that of laparoscopic group, the time for the return of serum 13-HCG to normal was longer than that of laparoscopic group, the differences were significant （ P all 〈 0.05）. But the amount of intraoperative bleeding and menstrual recovery time after operation had no significant difference （P 〉 0.05 ）. The duration of absorption of mass were（41 ± 4） days in hysteroscopic group, the mass were completely removed in laparoscopie group. Conclusions Two methods can be used for the treatment of exogenous CSP, however, laparoscopic group is better than that of hysteroscopic group in some cases. This management could repair the uterine seals, reduce the reoccurring risk and conservate the fertility potential.
出处
《中国实用医刊》
2017年第5期81-83,共3页
Chinese Journal of Practical Medicine
关键词
剖宫产瘢痕妊娠
子宫动脉栓塞术
宫腔镜
腹腔镜
Cesarean scar pregnancy
Uterine artery embolization
Hysteroscopy
Laparoscopy
