宫腔镜联合阴式病灶切除术治疗子宫瘢痕妊娠的临床效果

Clinical effects of hysteroscopy combined with transvaginal operation for cesarean scar pregnancy

目的探讨宫腔镜联合阴式病灶切除手术治疗子宫瘢痕妊娠(CSP)的有效性及安全性。方法回顾性分析子宫瘢痕妊娠病例92例,其中45例接受了宫腔镜联合阴式妊娠病灶切除术(研究组),47例接受了腹腔镜下妊娠病灶切除术(对照组),比较两组患者术中出血量、手术时间、费用、术后平均住院天数、一次性病灶完全清除率、血β-HCG降至正常时间及手术并发症发生率。结果研究组术中平均出血96.25 mL,手术时间56.69 min,术后平均住院2.77 d,住院费用4522.56元,血β-HCG降至正常时间是31.78 d,术中大量出血发生率2.22%,一次性病灶完全清除率100.00%,与对照组相比,各指标比较差异均有显著性(P<0.05),各指标均优于对照组。结论宫腔镜联合阴式妊娠病灶切除术治疗CSP手术效果好、安全性高,是一种可以选择的手术方式,值得临床进一步探讨。

[ Objective ] To study the treatment efficacy and safety of lesion resection by hysteroscopy combined with transvaginal operation for cesarean scar pregnancy （CSP）. [ Methods ] 92 cases of CSP were retrospectively analyzed, including 45 patients who received lesion resection by hysteroseopy combined with transvaginal operation （study group）, and 47 patients by laparoscopic operation （control group）, compared with the average intraoperative blood loss, operative time, surgical fees, mean postoperative hospitalization days, disposable lesions complete clearance rate, blood [3 -HCG recovery time, and rate of complications of the two surgical groups. [ Results ] Compared with the surgery of laparoscopy group, the surgical operation of hysteroscopy combined with transvaginal lesion resection group has the following advantages： averagely, less blood loss （96.25 mL）, shorter operation time （56.69 min）, shorter postoperative hospitalization days （2.77 d）, shorter blood [3-HCG recovery time （31.78 d）, higher disposable lesions complete clearance rate （100.00%）, and less fees （4522.56 RMB）, as well as lower massive hemorrhage inci- dence （2.22%）; The differences of above various indicators in the two groups were statistically significant （P 〈0.05）. [ Conclusion ] The lesion resection of CSP by hysteroscopy combined with transvaginal operation is an alternative effective and safe surgical treatment. It is worthy of further clinical study.