介入治疗、腹腔镜和经阴道3种途径在剖宫产切口瘢痕妊娠中的应用分析

Effect of Interventional Therapy, Laparoscope and Transvaginal Therapy on Focus in Patients with Cesarean Scar Pregnancy

目的:探讨剖宫产切口瘢痕妊娠(CSP)行介入治疗、腹腔镜下病灶切除和经阴道病灶切除术的可行性、疗效和安全性。方法:回顾性分析113例CSP患者资料,42例行腹腔镜治疗(A组),28例行介入治疗(B组),43例行阴式疤痕妊娠病灶切除(C组),分析术后hCG下降情况、月经复潮时间和再孕情况。结果:3组患者在年龄、孕次、术前hCG值、病灶大小、距前次剖宫产时间均无统计学差异(P>0.05)。A组和C组在术中出血、手术时间、住院时间上无统计学差异(P>0.05),两者均优于B组,差异有统计学意义(P<0.05),其中住院费用比较,B组最高,A组其次,C组最少。A组和C组hCG降至正常时间、病灶缩小所需时间、月经复潮时间短于B组,差异有统计学意义(P<0.01),C组术后hCG降至正常时间要短于A组。术后再孕C组7例(16.28%,7/43),A组5例(11.90%,5/42),均高于B组(0%,0/28)。结论:3种方法各有优缺点,介入组尤其适合发生大出血的CSP患者,腹腔镜和阴式2种方法直接清除病灶,修复瘢痕切口,术后恢复快,创伤小,但腹腔镜手术和介入均需要昂贵的器械,要具备丰富的手术操作经验,阴式瘢痕病灶清除相对简单,并发症少,不需要昂贵的器械,有一定阴式手术经验者即可开展,值得临床推广。

Objective： To evaluate feasibility, efficacy and safety of interventional therapy, laparoscope and transvaginal therapy on focus in patients with cesarean scar pregnancy （CSP）. Methods： A total of 113 patients with CSP were recruited and retrospectively analyzed, including 43 patients receiving transvaginal therapy （group A）, 28 patients receiving interventional therapy （group B） and 42 patients receiving laparoscope （group C）. Post operative hCG, time of menstruation, and re-pregnancy were analyzed. Results： There were no significant differences among age, frequency of pregnancy, preoperative hCG, focus size, time of late caesarean among the three groups （P〉0.05）. Blood loss during operation, length of procedure and length of hospitalization did not show significant differences between group C and group A （P〉0.05）, but were significantly lower than those in group B （P〈0.05）. Hospital expenditure was the highest in group B, followed by group C and group A. Time of hCG recovery, days of focus reduction, time of menstruation recovery were significantly shorter in groups A and C than in group B （P〈0.01）. Time ofhCG recovery was shorter in group A than in group C. Seven patients （16.28%, 7/43） occurred re-pregnancy in group A and 5 （11.90%, 5/42） in group C, which were higher than that of group B （0%, 0/28）. Conculsions： Feasibility, efficacy and safety of interventional therapy, laparoscope and transvaginal therapy on focus in patients with CSP were acceptable. Interventional therapy was optional in patients with caesarean due to massive hemorrhage, whereas laparo- scope therapy and intervanigal therapy are suitable for debridement, repair of scar due to fast restoration and mini-trauma after operation. Expenditure of interventional therapy and laparoscope are expensive compared with intrevaginal therapy, which is worth being recommend.