宫腔镜在保留剖宫产术后子宫瘢痕妊娠患者生育功能中的临床价值

Clinical value of hysteroscopy in the preservation of fertility of women with cesarean scar pregnancy

目的探讨宫腔镜在保留剖宫产术后子宫瘢痕妊娠（CSP）患者生育功能中的临床价值。方法选择2011年3月至2013年2月成都市第五人民医院收治的82例CSP患者为研究对象,根据宫腔镜使用情况,将其分为A组（n=42,使用宫腔镜）和B组（n=40,不使用宫腔镜）,再根据患者超声检查或MRI检查结果将上述两组进一步分为AⅠ亚组（n=22,内生型）、AⅡ亚组（n=20,外生型）及BⅠ亚组（n=20,内生型）、BⅡ亚组（n=20,外生型）。本研究遵循的程序符合成都市第五人民医院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书。各组患者一般情况比较,差异无统计学意义（P〉0.05）。比较各组患者的术中出血量、住院时间、术后血清β-人绒毛膜促性腺激素（hCG）水平恢复时间、治疗结果及术后并发症下等情况。结果 AⅠ亚组患者术中出血量、住院时间和血清β-hCG水平恢复时间均显著低于BⅠ亚组患者（190-150 mL vs 110-200mL,5-8dvs 6-9d,15-24dvs 18-35d）,两组比较,差异有统计学意义（t=2.160,2.052,2.440;P〈0.05）。AⅡ亚组患者术中出血量、住院时间和血清β-hCG水平恢复时间均显著低于BⅡ型患者（100-150mL vs 105-170mL,5-7dvs 6-8d,15-21dvs 18-24d）,两组比较,差异也有统计学意义（t=2.459,2.400,2.722;P〈0.05）。82例CSP患者中,无一例患者住院期间出现胃肠道刺激、口腔溃疡及内分泌紊乱等不良反应。A组和B组患者治疗效果比较,差异无统计学意义（χ2=1.063,P=0.302 5）。结论宫腔镜在CSP治疗中可降低术中出血少,缩短住院时间和术后血清β-hCG水平恢复时间,并且治疗不良反应小,为保留CSP患者的生育功能提供条件。

Objective To explore the application of hysteroscopy in preservation of fertility of women with cesarean scar pregnancy（CSP）. Methods From March 2011 to February 2013,a total of 82 women with CSP were included in the study. They were divided into group A （n=42, with hysteroscopy） and group B （n=40, without hysteroscopy） according to the usage of hysteroscopy. The group A were further divided into subgroup A Ⅰ （n = 22） and subgroup A Ⅱ （n = 20） according to their ultrasound and MRI results. Meanwhile, the group B were further divided into subgroup BⅠ （n =20） and subgroup BⅡ （n = 20） as well. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Chengdu Fifth Peoplers Hospital. Informed consent was obtained from each participants. There was no significant difference in general condition among these groups（P〉0.05）. The hospital stay, operative blood loss and recovery duration of serum β-human chorionic gonadotropin（hCG） level were compared among these groups. Results The hospital stay,operative blood loss and recovery duration of serum β-hCG in subgroup AⅠ were obviously lower than those of subgroup AⅡ （100-150 mL vs 105-170 mL,5-7 d vs 6-8 d, 15-21 d vs 18- 24 d）, and there were significant differences（t= 2. 459,2. 400,2. 722 ;P〈0.05 ）. The hospital stay, operative blood loss and recovery duration of serum β-hCG level in group A U were obviously lower than those of subgroup BⅡ（100-150 mL vs 105-170 mL,5-7 d vs 6-8 d, 15-21 d vs 18-24 d）,and there were significant differences（t= 2. 459,2. 400,2. 722;P〈0. 05）. No one had adverse reaction in the study. There was no significant difference in treatment effects between group A and group B （;（2 = 1. 063, P = 0. 302 5）. Conclusions The application of hysteroscopy in the diagnosis and treatment of CSP can decrease the operative blood loss,shorten the hospital stay and recovery duration of serum β-hCG level. It is a feasible operation mode,which provide the conditions for the preservation of fertility.