经阴道子宫下段妊娠病灶切除术治疗外生型剖宫产瘢痕妊娠的临床研究

Clinical study of treatment of exogenous cesarean scar pregnancy by transvaginal excision of lesion of lower uterine pregnancy segment

目的探讨经阴道子宫下段妊娠病灶切除术治疗外生型剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的临床效果。方法选取2011年2月至2016年1月在深圳市福田区妇幼保健院及深圳市妇幼保健院就诊的外生型CSP患者66例,其中使用经阴道子宫下段妊娠病灶切除术的30例患者为研究组,采用经腹子宫瘢痕妊娠病灶切除术的36例患者为对照组。比较两组患者的手术情况、术后恢复情况和术后不良反应发生情况。结果研究组患者手术时间、术中出血量、住院时间、住院费用都少于对照组,两组比较差异有统计学意义(P<0.05);研究组患者术后肛门排气时间短于对照组,差异有统计学意义(P<0.05);两组人绒毛膜促性腺激素恢复至正常水平时间、月经复潮时间、病灶缩小时间比较,差异无统计学意义(P>0.05);研究组患者切口液化、阴道流血、周围组织受损等不良反应发生情况均少于对照组,差异有统计学意义(P<0.05)。结论经阴道子宫下段妊娠病灶切除术治疗外生型CSP的临床效果优于经腹子宫瘢痕妊娠病灶切除术,患者损伤小,术后恢复快,不良反应少,值得临床选用。

Objective To discuss the clinical effects of excision of lesion of lower uterine pregnancy segment by transvaginal excision in treatment of cesarean scar pregnancy （CSP） and to provide a reference for the treatment of the disease. Methods 66 patients with exogenous cesarean scar pregnancy and who received treatments in the Maternal and Child Health Hospital of District Futian of Shenzhen City from February 2011 to January 2016 were selected. 36 cases were treated by abdominal uterine scar pregnancy lesion resection as the control group while 30 cases were treated with excision of lesion of pregnancy by transvaginal excision as thereserch group. Operation situation, the postoperative recovery situation and the postoperative adverse reactions occurred in the two groups were compared. Results The operation time, intraoperative blood loss, hospitalization time and costs of patients in the research group were less than those of the control group. The difference was statistically significant（ P 〈 0. 05 ）. The anal exhaust time after operation of patients in the research group was shorter than the control group. The difference was statistically significant （ P 〈 0. 05 ）. Time of HCG return to normal levels, menstrual cycle and lesion reduction time of the two groups were compared. The difference was not statistically significant （ P 〉 0. 05 ）. The incision liquefaction, vaginal bleeding, the number of peripheral tissue damage （2 cases） of patients in the research group were less than those in the control group （ a total of 7 cases）. The incidence of adverse reactions in the two groups were compared. The difference was statistically significant （ P 〈 0. 05 ）. Conclusion Clinical effect of excision lesion of lower uterine pregnancy segment by transvaginal excisionin treatment of cesarean scar pregnancy are better than excision of lesion of uterine scar pregnancy with less injury, rapid postoperative recovery and less adverse reactions. It is worthy to be selected clinical.