经阴道子宫瘢痕妊娠病灶切除术的临床应用分析

Clinical application of transvaginal cesarean scar pregnancy lesion resection

目的：探讨经阴道子宫瘢痕妊娠病灶切除术的临床应用。方法选择2012年6月至2015年8月在安康市人民医院接受手术治疗的剖宫产术后子宫瘢痕妊娠（ CSP）患者116例作为研究对象。依照数字随机表法将116例患者分为观察组及对照组，每组各58例，观察组给予经阴道CSP病灶切除术，对照组给予腹腔镜手术，比较两组的疗效。结果观察组的手术时间、住院费用均显著低于对照组（t值分别为19．906、4．028，均P＜0．05），两组术中出血量、住院时间比较均无显著性差异（t值分别为0．538、0．240，均P＞0．05）。两组患者治疗前血β-hCG水平无显著性差异（t＝0．203，P＞0．05），治疗后血β-hCG水平均显著下降（t值分别为239．599、131．166，均P＜0．05），但治疗后两组之间比较无显著性差异（t＝1．902，P＞0．05）。观察组有2例感染、1例淋漓阴道出血，对照组有3例感染、1例麻醉并发症，两组术后总并发症比较无显著性差异（χ2＝0．152，P＞0．05）。结论经阴道CSP病灶切除术治疗CSP患者可获得较好疗效，操作简便，安全性较高，值得在妇科临床上进行推广应用。

Objective To explore the clinical application of transvaginal cesarean scar pregnancy （ CSP） lesion resection.Methods Totally 116 cases of CSP accepting operative treatment from June 2012 to August 2015 were selected and were divided into observation group and control group according to digital random table method （ with 58 cases in each group） .Observation group was treated by transvaginal CSP lesion resection, while control group was treated by laparoscopic surgery.Curative effects were compared between two groups.Results The operation duration and hospitalization expenses in the observation group were significantly lower than those in the control group （ t value was 19.906 and 4.028, respectively, both P〈0.05）, but there was no significant difference in intraoperative blood loss and length of hospital stay between two groups （t value was 0.538 and 0.240, respectively, both P〉0.05）.There was no significant difference in serumβ-hCG level before treatment between two groups （t=0.203,P〉0.05）, but it decreased significantly after treatment in two groups （t value was 239.599 and 131.166, respectively, both P 〈0.05）.There was no significant difference in the serum β-hCG levels after treatment between two groups （t=1.902,P〉0.05）.There were 2 cases of infection and 1 case of dripping wet vaginal bleeding in the observation group, and there were 3 cases of infection and 1 case of anesthesia complications in the control group.However, there was no significant difference in total postoperative complications between two groups （χ2 =0.152,P〉0.05）.Conclusion The treatment of vaginal CSP lesion resection can obtain good curative effect, simple operation and high safety.It is worthy of popularization and application in gynecological clinics.