三种方法治疗剖宫产术后子宫切口瘢痕妊娠42例临床疗效分析

Analysis on the clinical effects of 3 different surgical methods in the treatment of 42 cases of cesarean scar pregnancy

目的分析比较超声监视下清宫术、宫腔镜电切术及经阴道病灶切除术治疗剖宫产术后子宫切口瘢痕妊娠(caesarean scar pregnancy,CSP)的临床疗效。方法回顾性分析2012年1月至2015年1月沈阳市第四人民医院妇科收治的42例CSP患者的临床资料,分为超声监视下清宫组10例、宫腔镜电切组14例、经阴道病灶切除术组18例。比较术中、术后出血量、手术时间、术后住院时间及术后血β-HCG转阴时间、术后月经来潮时间、术后1个月TVS子宫下段前壁肌层厚度。结果术中术后出血量、手术时间、术后住院时间,超声监视下清宫组、宫腔镜电切组与经阴道病灶切除术组比较差异有统计学意义(P<0.01或P<0.05);术后血β-HCG转阴时间、术后月经来潮时间、术后1个月TVS子宫下段前壁肌层厚度超声监视下清宫组、宫腔镜电切组与经阴道病灶切除术组比较差异有统计学意义(P<0.01);术中出血量与CSP病灶大小呈正相关(P<0.05),与肌层厚度呈负相关(P<0.05)。结论 3种术式均能有效治愈CSP;超声监视下清宫术及宫腔镜电切术治疗CSP时间短、创伤小、效率低;经阴道病灶切除术治疗CSP时间长、创伤大、效率高;CSP术中出血量与病灶大小呈正相关,与肌层厚度呈负相关;但经阴道病灶切除术可有效治疗瘢痕处憩室。

Objective To compare and analyze the clinical effects of 3 different surgical methods（ ultrasonic guided curettage,hysteroscopy and transvaginal surgery） on cesarean scar pregnancy（ CSP）. Methods A retrospective analysis was made on the42 patients with CSP admitted into the Forth Shenyang People＇s Hospital from January 2012 to January 2015. The patients were divided into the ultrasound guided curettage group（ n = 10）,the hysteroscopic electric surgery group（ n = 14） and the transvaginal surgery group（ n = 18）. Comparisons were made between the 3 groups in such data as hemorhage during surgery and after surgery,surgical time,duration of stay in the hospital after surgery,the time taken for β-human chorionic gonadotropin（ β-HCG） to change from positive to negative,the time taken for the montrual onset after surgery,and the muscle thickness of anterior wall of TVS lower uterine segment1 month after surgery. Results Statistical significance could be seen in the amount of hemorhage during surgery and after surgery,surgical time,duration of stay in the hospital after surgery,when the data of the ultrasound guided curettage and the hysteroscopic electric surgery groups were compared with those of the transvaginal surgery group（ P〈0. 01 or P〈0. 05）. Significant differences could also be noted in the time taken for β-human chorionic gonadotropin（ β-HCG） to change from positive to negative,the time taken for the montrual onset after surgery and muscle thickness of anterior wall of TVS lower uterine segment 1 month after surgery,when the data of the ultrasound guided curettage and the hysteroscopic electric surgery groups were compared with those of the transvaginal surgery group（ P〈0. 01）. The amount of hemorhage during surgery was positively correlated with the foci of CPS（ P〈0. 05）,but was negatively associated with the muscle thickness of anterior wall of TVS lower uterine segment（ P〈0. 05）. Conclusion The 3 surgical methods could all effectively cure CSP. Ultrasonic guided curettage and hysteroscopic electric surgery had the features of shorter surgical time,minor trauma,but lower efficacy,while on the other hand,transvaginal surgery had the features of longer surgical time,severer trauma,but higher efficacy. The amount of hemorhage during surgery was positively correlated with the foci of CPS,but was negatively associated with the muscle thickness of anterior wall. However,transvaginal surgery could effectively treat previous cesarean scar diverticulum.