宫腔镜下子宫瘢痕妊娠物电切联合清宫术治疗瘢痕妊娠的临床研究

A clinical study on treatment of Cesarean scar pregnancy by hysteroscopic electrosurgery of pregnancy tissue combined with uterine curettage

目的:探讨宫腔镜下子宫瘢痕妊娠物电切联合清宫术治疗瘢痕妊娠(CSP)的临床效果。方法:选取2016年1月至2019年1月我院收治的CSP患者60例,随机分为对照组和观察组,各30例。对照组予以药物联合清宫术,观察组给予宫腔镜下妊娠物电切术联合清宫术治疗。比较两组手术时间、术中出血量、住院时间、术后3 d、4 dβ-HCG下降幅度、β-HCG转阴时间、月经来潮时间、术后妊娠物残留率、并发症发生率。结果:观察组术中出血量少于对照组,住院时间短于对照组(均P<0.05)。观察组术后3 d、4 dβ-HCG下降幅度大于对照组,β-HCG转阴时间、月经来潮时间短于对照组(均P<0.05)。观察组妊娠物残留率低于对照组(P<0.05)。两组并发症发生率差异无统计学意义(P>0.05)。结论:宫腔镜下子宫瘢痕妊娠物电切联合清宫术治疗瘢痕妊娠成功率较高,可减少术中出血量,促进患者恢复,安全可靠。

Objective:To investigate the clinical efficacy of hysteroscopic electrotomy of pregnancy tissue combined with uterine curettage as a treatment of Cesarean scar pregnancy(CSP).Methods:Sixty CSP patients admitted to our hospital between January 2016 and January 2019 were enrolled and randomized into the study group and control group(n=30 each).The control group was treated on medications combined with uterine curettage,while the study group was given hysteroscopic electrotomy of pregnancy tissue combined with uterine curettage.The operation time,intraoperative blood loss,hospital stay,HCG decline at 3 d and 4 d after surgery,time to seroconversion ofβ-HCG,time to recovery of menstrual periods,postoperative residue of pregnancy tissues,and incidence of complications were compared between the two groups.Results:Compared with the control group,the study group experienced less intraoperative blood loss,shorter hosptial stay,greater decline in HCG at 3 d and 4 d postoperatively,shorter time to seroconvrsion ofβ-HCG,shorter time to recovery of menstrual periods and lower rate of residue of pregnancy tissues(allP<0.05).There was no significant difference in the complication rate between the two groups(P>0.05).Conclusion:Hysteroscopic electrotomy of pregnancy tissue combined with uterine curettage as a treatment of CSP leads to higher success rate,with less intraoperative blood loss,expedited recovery,good safty and reliability.