经阴道手术治疗剖宫产疤痕妊娠的临床分析

Transvaginal Surgical Management of Cesarean Scar Pregnancy: Clinical Analysis of 80 Cases from One Tertiary Medical Center

【目的】回顾性分析经阴道手术治疗剖宫产疤痕妊娠（CSP）的有效性和安全性。【方法】对2009年12月至2014年12月在我院行经阴道手术治疗的80例CSP患者的临床资料进行回顾性分析。其中,经阴道手术治疗前未接受任何治疗的患者（初次治疗组）54例,经阴道手术治疗前曾接受其他治疗的患者（补救治疗组）26例,比较两组患者术前、术中和术后临床指标的情况。【结果】所有患者的平均手术时间、术中估计出血量、术后住院时间、住院费用、血β-h CG恢复时间、月经恢复时间、手术成功率、术中并发症率、术后并发症率和总并发症率分别为（56±31）min、50（22~50）m L、（4.7±2.8）d、（9013±3244）元、（3.0±1.6）周、（1.22±0.49）月、97.50%、6.25%、12.50%和16.25%。初次治疗组患者平均手术时间、术中估计出血量、术后住院时间、住院费用、月经恢复时间、术中并发症率、术后并发症率和总并发症率均低于补救治疗组患者,其中两组患者平均手术时间、住院费用、术中并发症率和总并发症率之间差异具有统计学意义（均P〈0.05）;初次治疗组患者血β-h CG恢复时间和手术成功率均高于补救治疗组患者,其中两组患者血β-h CG恢复时间之间差异有统计学意义（P〈0.001）。【结论 】经阴道手术治疗CSP是安全、有效的,可作为CSP的首选治疗方法之一。

[ Objective ] To estimate the safety and efficacy of transvaginal surgical management of cesarean scar pregnancy （CSP）. [ Methods ] A total of 80 patients diagnosed with CSP received transvaginal surgical management in our hospital from December 2009 to December 2014. Primary treatment group （54 patients） defined as patients have not received any treatment before transvaginal surgical management. Rescue treatment group （26 patients） referred to the patients received any previous treatment. Preoperative, intraoperative and postoperative data of both groups were collected and analyzed retrospectively. [ Results ] Operative time, estimated blood loss, postoperative hospital stay, hospitalization expenses, serum β-hCG resolution time, menstruation recovery time, success rate, intraoperative complication rate, postoperative complication rate and total complication rate in all patients were （56 ± 31 ） min, 50（22 ± 50） mL, （4.7 ± 2.8） d, （9013 ± 3244） RMB yuan, （3.0 ± 1.6） weeks, （1.22± 0.49） month, 97.50%, 6.25%, 12.50%, and 16.25%, respectively. There were lower operative time, estimated blood loss, postoperative hospital stay, hospitalization expenses, menstruation recovery time, intraoperative complication rate, postoperative complication rate and total complication rate in primary treatment group, and there were statistically significant in operative time, hospitalization expenses, intraoperative complication rate and total complication rate between the two groups （P 〈 0.05）. There were higher serum β-hCG resolution time and success rate in primary treatment group, with P 〈 0.001 and P = 0.103 respectively. [ Conclusion ] Transvaginal surgery is an effective and safe management option for CSP patients.