宫腔镜治疗病灶最大径线≤2．5cm的内生型剖宫产术后子宫瘢痕妊娠的疗效观察

Therapeutic effect of hysteroscopic surgery in treatment of small mass of caesarean scar pregnancy

目的探讨宫腔镜手术治疗病灶最大径线≤2．5em的内生型剖宫产术后子宫瘢痕妊娠（CSP）的价值。方法回顾性分析2000年1月至2013年1月在河南省漯河市中心医院住院治疗的CSP患者的临床资料，选择病灶最大径线≤2．5em的内生型CSP患者61例，按照治疗方法的不同分为宫腔镜组21例，行宫腔镜手术；药物＋清宫组23例，给予甲氨蝶呤＋清宫术；栓塞＋清宫组17例，行双侧子宫动脉栓塞＋清宫术。比较3组患者的术中出血量、手术时间、治疗后住院时间、血清[3-hCG转为正常的时间。结果宫腔镜组出血量、治疗后住院时间、血清B—hCG转为正常的时间分别为（49．8±6．2）ml、（3．5±0．8）d、（21．2±2．4）d，药物＋清宫组分别为（87．0±30．5）ml、（12．5±1．0）d、（29．6±2．2）d，两组各项指标分别比较，差异均有统计学意义（P〈0．05）；宫腔镜组手术时间为（33_-4-4）min，药物＋清宫组为（35±6）min，两组比较，差异无统计学意义（P〉0．05）。宫腔镜组治疗后住院时间短于栓塞＋清宫组的（4．5±0．6）d，两组比较，差异也有统计学意义（P〈0．05），宫腔镜组与栓塞＋清官组的手术时间[分别为（33±4）、（31±4）min]、术中出血量[分别为（49．8±6．2）、（46．2±2．8）m1]、血清13-hCG转为正常的时间[（21．2±2．4）、（23．1±2．6）d]比较，差异均无统计学意义（P〉0．05）。结论宫腔镜手术治疗病灶最大径线≤2．5cm的内生型CSP有效、住院时间短、恢复快．值得推广。

Objective Study the effect of hysteroscopic surgery in treatment of small mass of caesarean scar pregnancy（CSP）. Methods From January 2000 to January 2013, 61 cases lesions P〈2. 5 cm diameter of endogenous CSP undergoing treatment in Luohe Central Hospital were studied retrospectively. According to different treatment, they were divided into 21 cases in hysteroseopic surgery group, 23 cases in methotrexate ＋ operation group and 17 cases in bilateral uterine artery embolism ＋ curettage group. Intraoperative blood loss, operative time, hospitalization time after treatment and β-hCG to normal time were compared among those three groups. Results The surgical blood loss, hospitalization time after treatment, β-hCG to normal time were （ 49. 8 ± 6. 2 ） ml, （ 3.5 ± 0. 8 ） days, （ 21.2 ± 2.4 ） days in hysteroscopie group, （87.0 ±30. 5） ml, （ 12. 5 ± 1.0） days, （29.6 ±2. 2） days in methotrexate ＋ operation group, the difference was statistically significant （ P 〈 0. 05 ）. The operation time were （ 33 ± 4） minutes in hysteroscopic surgery group and （ 35 ± 6） minutes in methotrexate ＋ operation group, which did not reached significant difference （ P 〉 0. 05 ）. Length of hospital stay after treatment of hysteroseopie surgery group is less than the bilateral uterine artery embolism ＋ curettage group significantly （P 〈 0. 05 ）. Operation time, surgical bleeding and β-hCG to normal time had no obvious difference between hysteroscopie surgery and in bilateral uterine artery embolism ＋ curettage group （ P 〉 0. 05 ）. Conclusion Hysteroscopy surgery in treatment of small mass endogenous CSP is effective, shorter hosoitalization time. ouick reeoverv.