宫腔镜联合清宫术治疗剖宫产瘢痕妊娠临床观察

Clinical observation of hysteroscopy combined with curettage for treatment of cesarean scar pregnancy

目的研究宫腔镜联合清宫术治疗剖宫产瘢痕妊娠的临床效果。方法选择2013年1月至2015年12月在汉中市人民医院妇产科就诊的剖宫产瘢痕妊娠患者75例,按照随机数字表法将患者分为研究组(38例)和对照组(37例)。对照组患者采用常规清宫术治疗,研究组在对照组基础上联合宫腔镜治疗,记录两组患者手术时间、术中出血量、子宫恢复时间、手术前后β-h CG水平、住院时间,比较两组患者的手术效果。结果研究组患者手术时间、术中出血量、子宫恢复时间均显著低于对照组(t值分别为2.351、2.273、2.415,均P<0.05)。手术前两组患者β-h CG水平比较无显著性差异(t=2.254,P>0.05),研究组患者手术后3d血β-h CG水平下降幅度达(69.93±3.49)%,对照组下降幅度为(41.48±4.42)%,研究组显著高于对照组(t=2.169,P<0.05),且研究组β-h CG水平恢复正常所需时间显著低于对照组(t=2.181,P<0.05)。研究组患者手术成功38例,成功率为100.00%,对照组患者手术成功33例,成功率为89.19%,显著低于研究组(χ~2=6.398,P<0.05)。结论宫腔镜联合清宫术能够显著提高剖宫产瘢痕妊娠患者的治疗成功率,显著降低患者手术时间和术中出血量,β-h CG水平较快恢复,具有较好的临床应用价值。

Objective To study the clinical effect of hysteroscopy combined with curettage for the treatment of cesarean scar pregnancy（CSP）.Methods Seventy-five cases of CSP were selected from January 2013 to December 2015 in department of obstetrics of the People＇s Hospital of Hanzhong City.According to random number table method the cases were divided into study group（38 cases） and control group（37 cases）.The control group was treated with conventional curettage treatment,while the study group received hysteroscopy based on the treatment for the control group.Operation time,bleeding volume during operation,recovery of the uterus,level of β-h CG before and after surgery,and hospitalization time were recorded for two groups of patients to compare surgery effect.Results The operation time,intraoperative blood loss and uterine recovery time in the study group were significantly lower than those of the control group（t value was2.351,2.273 and 2.415,respectively,all P〈0.05）.There was no significant difference in β-h CG level before surgery between two groups（t=2.254,P〉0.05）.The decline of β-h CG level 3 days after surgery in the study group and the control group was（69.93 ±3.49） % and（41.48 ± 4.42） %,respectively,and that of the study group was significantly higher than the control group（t=2.169,P〈0.05）.The time for β-h CG level back to normal in the study group was significantly shorter than that in the control group（t=2.181,P〈0.05）.There were 38 patients with successful operation in the study group,and the success rate was 100.00%.There were 33 patients with successful operation in the control group,and the success rate was 89.19%（χ~2=6.398,P〈0.05）.Conclusion Hysteroscopy combined with uterine curettage can improve the success rate of treatment for CSP and reduce the operative time and the amount of bleeding during operation significantly.The level of β-HCG recovers rapidly.It has good clinical application value.