摘要
目的探讨刨宫产术后子宫瘢痕妊娠(CSP)的手术方法和疗效。方法回顾性分析解放军202医院妇产科自2012年1月至2015年12月收治的60例CSP患者的临床资料。根据手术方法不同,分为清宫组(超声引导下行清宫术)11例、腹腔镜组(腹腔镜下病灶切除术)16例、宫腔镜组(宫腔镜下病灶切除术)12例,阴式组(经阴道入路病灶切除术)21例。观察各组患者血液β人绒毛膜促性腺激素(β-HCG)恢复至正常水平所需时间、术后住院时间、术中失血量情况,并进行比较分析。结果本研究中,4组患者均未行开腹手术,手术均顺利完成。其中,清宫组术中出血量[(208±22)ml]最多,明显高于腹腔镜组[(40±13)ml]、宫腔镜组[(140±55)ml]和阴式组[(165±38)ml],差异均有统计学意义(P<0.05);腹腔镜组术中出血量少于宫腔镜组及阴式组(P<0.01);而宫腔镜组与阴式组比较,差异无统计学意义(P>0.05)。清宫术手术时间[(16±5)min]最短,明显少于腹腔镜组[(40±13)min]、宫腔镜组[(140±55)min]和阴式组[(165±38)min],差异均有统计学意义(P<0.05);且腹腔镜组与宫腔镜组及阴式组比较,差异也均有统计学意义(P<0.05)。清宫组血液β-HCG恢复至正常水平所需时间[(50±3)d]最长,与腹腔镜组[(21±3)d]、宫腔镜组[(20±2)d]和阴式组[(22±3)d],差异均有统计学意义(P<0.05)。宫腔镜组住院时间[(15.0±2.1)d]最长,清宫组住院时间[(4.1±1.1)d]最短,与腹腔镜组[(7.5±2.3)d]及阴式镜组[(8.3±1.0)d]比较,差异均有统计学意义(P<0.05);而腹腔镜组与宫腔镜组间比较,差异无统计学意义(P>0.05)。结论清宫术、阴式手术及腹腔镜引导、宫腔镜引导下的微创手术均是CSP的有效治疗方法。虽然清宫术方法简单、住院时间短,但创伤较大、术后恢复期长。腹腔镜下病灶切除术在术中出血量和手术时间方面,明显优于宫腔镜手术和阴式手术。
Objective To investigate the surgical methods and therapeutic effect on scar pregnancy( CSP) after cesarean section.Methods A retrospective analysis on 60 cases with CSP was performed in this study,in the Department of Obstetrics and Gynecology in our hospital,from January 2012 to December 2015. According to the different surgical methods,11 cases in curettage group( ultrasound guided curettage),16 cases in laparoscopic group( laparoscopy assisted lesion resection),12 cases in hysteroscopy group( hysteroscopy assisted lesion resection),and 21 cases in vaginal group( lesion resection through vagina). Bloodβhuman chorionic gonadotropin( β-HCG) time restoring to the normal level,postoperative hospitalization time,intraoperative bleeding situation were observed and comparatively analyzed. Results All patients in the 4 groups were cured without open surgery. The bleeding volume in curettage group[( 208 ± 22) ml]was significantly higher than that in laparoscopic group[( 40 ± 13) ml],hysteroscopy group[( 140 ± 55) ml]and vaginal group[( 165 ± 38) ml],P 〈 0. 05. The operation time in curettage group[( 16 ± 5) minutes]was significantly shorter than that in laparoscopic group[( 40 ± 13) minutes],hysteroscopy group[( 140 ± 55) minutes]and vaginal group[( 165 ± 38) minutes],P 〈 0. 05.Blood β-HCG time restoring to normal level in curettage group[( 50 ± 3) days]was significantly longer than that in laparoscopic group[( 21 ± 3) days],hysteroscopy group[( 20 ± 2) days]and in vaginal group[( 22 ± 3) days],P 〈 0. 05. The hospitalization time in hysteroscopy group[( 15. 0 ± 2. 1) days]was significantly the longest,in curettage group[( 4. 1 ± 1. 1) days]was the shortest,when compared with that in laparoscopic group [( 7. 5 ± 2. 3) days]and vaginal group [( 8. 3 ± 1. 0) days],P 〈 0. 05. Conclusion Effective treatment methods of CSP are curettage,vaginal surgery,laparoscopic guided surgery and minimally invasive surgery guided by hysteroscopy. Although the curettage method is simple,time of hospitalization is shorter; while,the trauma is great,and postoperation recovery period is long. Laparoscopic lesion resection is obviously better than hysteroscopy and vaginal surgery in the intraoperative bleeding volume and operation time.
出处
《临床军医杂志》
CAS
2016年第3期266-269,共4页
Clinical Journal of Medical Officers
关键词
瘢痕妊娠
刨宫产
腹腔镜
宫腔镜
清宫术
子宫动脉栓塞术
Cesarean scar pregnancy
Cesarean section
Laparoscope
Hysteroscopy
Curettage
Uterine arterial embolization