经阴道与经腹腔镜治疗外生型剖宫产瘢痕妊娠临床疗效分析

Therapeutic effects of transvaginal and laparoscopic operative methods in treating patients with cesarean scar pregnancy

目的探讨经阴道和经腹腔镜两种手术方式治疗外生型剖宫产瘢痕部妊娠(CSP)的临床疗效。方法回顾性分析郑州大学第二附属医院2012年6月至2014年7月间经手术治疗的63例外生型CSP患者的临床资料,其中35例经阴式手术治疗(A组),28例经腹腔镜下手术治疗(B组)。比较两组的手术时间、术中出血量、术后住院时间、住院费用、术后并发症、术后β-HCG下降情况及月经恢复时间。结果 63例手术均成功。两组患者年龄、孕次、剖宫产次数、停经时间、术前血β-HCG值、病灶大小、距末次剖宫产时间差异无统计学意义(P>0.05);A组的手术时间及术中出血量明显少于B组(P<0.05);术后住院时间、血β-HCG降至正常时间及月经恢复时间两组差异无统计学意义(P>0.05);A组的住院费用明显低于B组(P<0.05)。结论阴式和腹腔镜两种术式均能完整清除外生型CSP病灶,创伤小、恢复快、安全可行、疗效确切;有经阴道手术指征者经阴手术较经腹腔镜手术更快捷、更微创、更易行,且费用低、并发症少、不需要昂贵器械,值得临床推广应用。

Objective To explore the clinical effects of transvaginal and laparoscopic operative methods in treating pa- tients with cesarean scar pregnancy （CSP）.Methods The clinical data of 63 cases experiencing surgeIy for exogenous type CSP in our hospital from June 2012 to July 2014 were retrospectively analyzed. Among the 63 cases, 35 cases were performed with transvaginal surgery, 28 cases with laparoscopic surgery.The operational time and blood volume, the time after operation and cost in hospital, the postoperative complications, the time required for blood β-HCG returning to nor- mal and menstrual recovery were observed in the two groups.Results Surgery was fulfilled in 63 patients.There were no statistical differences in the age, pregnant time, cesarean time, gestational age, the blood β-HCG level before treatment, CSP mass size and the interval from the last cesarean delivery between the two groups （P〉0. 05）; The operational time and blood volume in A group were significantly less than group B （P〈0.05）; There were no statistical differences in the time after operation in hospital, the time requiring for blood β-HCG returned to normal and menstrual recovery between the two groups（P〉0.05）; The average hospital costs in A group were significantly less than group B（P〈0.05）. Conclusion Transvaginal and laparoscopic surgery can completely remove exogenous type CSP lesion, both with mild trauma, rapid recovery, more safety and effectiveness. Transvaginal surgery is faster and less invasive with simple han- dling, lower cost and fewer complications than the laparoscopic surgery, which does not require expensive equipment and should be applied in more clinical practice.