腹腔镜手术治疗早期外生型剖宫产术后子宫瘢痕妊娠的疗效观察

Laparoscopic management of early exogenous cesarean scar pregnancy after cesarean section

目的探讨腹腔镜手术治疗早期外生型剖宫产术后子宫瘢痕妊娠(CSP)的安全性及可行性。方法选取2010年7月至2015年10月在河北省沧州市中心医院诊治的54例早期外生型剖宫产术后子宫瘢痕妊娠患者的临床资料,进行回顾性分析,按不同治疗方式将54例患者分为:宫腔镜治疗组(21例),行宫腔镜病灶切除术;腹腔镜组(33例),行腹腔镜下病灶切除术+子宫修补术;分析其治疗结局。结果 1治疗方式:宫腔镜组21例中,4例治疗失败,2例因病灶外凸术中大量出血,转行开腹病灶切除术,2例因淋漓阴道出血,宫腔占位二次住院行清宫术无效改为开腹病灶切除术,治疗成功17例;33例腹腔镜组中6例因病灶明显凸出于子宫浆膜,子宫浆膜层菲薄,加行双侧子宫动脉阻断术,33例均一次治疗成功。2手术时间及住院时间:宫腔镜组:手术时间(41±5)min、术后住院时间(5.2±0.9)d,腹腔镜组:手术时间(66±18)min、术后住院时间(3.9±0.9)d,2组住院时间及手术时间相比较,差异均有统计学意义(P<0.05)。3治疗成功率:与宫腔镜组比较,腹腔镜组治疗成功率明显升高,2组差异有统计学意义(P<0.05)。结论腹腔镜下病灶切除+子宫修补术及子宫动脉阻断具备安全、疗效确切等优点,是治疗早期外生型剖宫产术后子宫瘢痕妊娠的有效方法。

Objective The objective of the study was to evaluate the efficacy and safety of laparoscopic management of early exogenous cesarean scar pregnancy（CSP）after cesarean section.Methods A retrospective analysis was performed on 54 patients of exogenous CSP in Cang Zhou City Central Hospital from July 2010 to October 2015,They were divided into two groups according to different treatment,group A（laparoscopic resection,n=33）,group B（hysteroscopic resection,n=21）.The clinical efficacy of two groups was analyzed.Results All33 patients were cured without the second operation in group A.17 of 21patients underwent hysteroscopy were cured in group B.The cure rate in group A was significantly higher than that in group B,there was statistically significant difference（P 〈0.05）.The difference of time for postoperative hospital stay and operative duration between group A and group C was statistically significant（P 〈0.05）.Conclusion Laparoscopy can remove ectopic gestational tissue and allow subsequent myometrial defect repair.This procedure is especially suitable for the treatment of exogenous CSP.It is also an effective and safe therapy for early exogenous cesarean scar pregnancy after cesarean section.