剖宫产瘢痕妊娠的临床特点及不同临床类型治疗结果的回顾性分析

Clinical Characteristics of Cesarean Scar Pregnancy and Outcomes of Different Types with Different Treatments:A Retrospective Analysis

目的分析剖宫产瘢痕妊娠(CSP)的临床特点,探讨不同类型CSP的治疗方式,为今后临床治疗方案的选择提供依据。方法回顾性分析2009年1月至2011年9月我院诊治的CSP患者185例,统计CSP的临床特点,比较相同手术方式治疗内生型及外生型CSP的差异性,并分析内生型及外生型CSP在不同治疗方式下的治疗结局。结果 (1)宫腔镜治疗的患者中,内生型CSP术中出血量、住院天数、术后住院时间均少于外生型CSP,差异具有统计学意义(P值分别为0.000,0.027,0.002);(2)清宫术治疗的患者中,内生型CSP的手术时间明显短于外生型CSP,差异具有统计学意义(P=0.004);(3)内生型CSP手术治疗方式中,宫腔镜电切术的术中出血量、手术时间及术后住院时间优于阴式病灶切除术,差异具有统计学意义(P值分别为0.015,0.001,0.021);(4)外生型CSP治疗中,宫腔镜电切术手术时间少于清宫术、阴式病灶切除术及经腹病灶切除术,差异有统计学意义(P值分别为0.013,0.025,0.000);宫腔镜电切术术中出血量少于清宫术,差异有统计学意义(P=0.035);(5)其他各项比较,差异无统计学意义(P>0.05)。结论内生型CSP选择宫腔镜电切术,可减少手术时间及术中出血量,二次处理的比例相对较低;外生型CSP可进行经腹病灶切除术,能减少二次处理的风险,但创伤较大。此外,阴式病灶切除术可能成为治疗CSP的一种新的微创治疗方案。

Objective To observe the clinical characteristics of cesarean scar pregnancy（CSP）,and to discuss how to choose the therapy according to its type.Methods The clinical characteristics of 185 patients dignosed as cesarean scar pregnancy and treated in Shengjing Hospital of China Medical University from January 2009 to September 2011 were retrospectively analyzed.The clinical features of CSP were summerized and differences were compared in outcomes between endogeous and exogeous CSP managed by the same treatment.Results（1） Hysteroscopy was significantly superior for endogeous type than for exogenous type in blood loss,operative time,and postoperative hospital stay,whose P values were respectively 0.000,0.027 and 0.002;（2） Curettage was better for endogenous type than exogenous type in operative time with the P value of 0.004;（3） For endogenous CSP,hysteroscopic resection was better than transvaginal approach in blood loss,operative time,and postoperative hospital stay with the P value of 0.015,0.001,and 0.021,respectively;（4） Hysteroscopic resection of exogenous CSP was better than curettage,transvaginal hysterotomy and abdominal hysterotomy in operation time with the P values of 0.013,0.025,and 0.000,respectively;（5） Hysteroscopic resection of exogenous CSP was better than curettage in blood loss with the P value of 0.035;（6） No significant differences in other parameters were noted（P 〉 0.05）.Conclusion Endogenous CSP treated by hysteroscopic surgery can reduce the operation time and blood loss with low secondary treatment.Treatment of exogenous CSP by abdominal hysterotomy can reduce the risk of secondary treatment,but has greater trauma.In addition,hysterotomy by transvaginal approach may become a new minimally invasive treatment for CSP.