宫腔镜联合清宫术治疗内生型剖宫产瘢痕妊娠的临床疗效及安全性分析

Clinical efficacy and safety of hysteroscopic combined with curettage in the treatment of endogenous type of cesarean scar pregnancy

目的 探讨宫腔镜联合清宫术治疗内生型剖宫产瘢痕妊娠（CSP）的临床疗效及安全性.方法 选取2014年2月至2015年7月66例内生型CSP患者,根据手术方式不同分为对照组33例和研究组33例.对照组采用腹腔镜手术治疗,研究组采用宫腔镜联合清宫术治疗.统计两组临床疗效、并发症发生率,并对比两组手术情况及术后恢复情况[血β-人绒毛膜促性腺激素（β-HCG）恢复正常时间、月经恢复正常时间、肛门排气时间].结果 研究组治疗有效率（93.94%）高于对照组（72.73%）,差异有统计学意义（P〈0.05）;研究组手术用时、术中出血量、住院时间、月经及血β-HCG恢复正常时间、肛门排气时间少于对照组,差异有统计学意义（P〈0.05）,术后两组宫腔引流时间比较差异未见统计学意义（P〉0.05）;研究组并发症发生率（6.06%）与对照组（9.09%）比较差异未见统计学意义（P〉0.05）.结论 采用宫腔镜联合清宫术治疗内生型剖宫产瘢痕妊娠效果显著,可有效减少手术用时、出血量,促进术后机体功能及早康复,改善临床疗效,且安全性较高.

Objective To investigate the the clinical efficacy and safety of hysteroscopy combined with curettage in the treatment of endogenous type of cesarean scar pregnancy （CSP）.Methods Sixty-six patients with endogenous type of CSP were selected from February 2014 to July 2015.According to the different surgical methods,they were divided into control group （n=33） and study group （n=33）.The control group was treated by laparoscopic operation,the study group was treated by hysteroscopy combined with uterine curettage.The clinical curative effect,complication rate of the two groups were collected,and the surgery and postoperative recovery [blood beta hCG（β-HCG）recovery time,menstrual recovery time,anal exhaust time] of the two groups were compared.Results The effective rate of the study group （93.94%） was higher than that of control group （72.73%）,the difference was significant （P〈0.05）;the operative time,amount of bleeding,hospitalization time,menstruation and serum β-HCG recovery time,anal exhaust time of the study group were less than those of the control group,the differences were statistically significant （P〈0.05）;The uterine cavity drainage time between the two groups after operation showed no significant difference （P〉0.05）;The complication rate had no significant difference between the study group （6.06%） and the control group （9.09%,P〉0.05）.Conclusions The effect of hysteroscopy combined with curettage in the treatment of endogenous type of cesarean scar pregnancy is significant,it can effectively reduce the operation time,bleeding volume,promote early recovery of postoperative body function,improve clinical curative effect,and has high safety.