宫腔镜终止剖宫产术后子宫瘢痕妊娠的疗效和安全性评估

Efficacy and safety of hysteroscopy in the treatment of uterine scar pregnancy after termination of cesarean section

目的:探讨宫腔镜终止剖宫产术后子宫瘢痕妊娠的临床效果,并评估相关不良反应的发生情况。方法:对137例子宫瘢痕妊娠患者进行分组研究,A组45例实施传统清宫术治疗,B组45例实施介入后药物杀胚再清宫,C组47例实施宫腔镜手术治疗。观察三组的手术情况和术后临床指标以及治疗有效率,并比较不良反应发生情况。结果:对三组患者的手术耗时以及术中的出血情况进行统计和比较,存在组间统计学差异(均P<0.05);在术后临床指标方面,C组的阴道流血天数、β-HCG水平复常时间、住院天数、月经恢复时间均显著短于A、B组,均P<0.05;经疗效评定和比较,C组评估为显效的一共31例,总有效率为97.87%,显著高于A组的77.78%和B组的80.00%,P<0.05;三组术后均出现一定的不良反应,包括发热和下腹疼痛等,但不良反应发生率经比较存在组间差异,A、B组均显著高于C组,P<0.05。结论:对于剖宫产术后子宫瘢痕妊娠患者实施宫腔镜临床疗效确切,可以获得理想的治疗效果,且不良反应轻微,是一种安全有效的治疗方案。

Objectives： To investigate the clinical effect of hysteroscopy in the treatment of uterine scar pregnancy after termination of cesarean section, and to evaluate the incidence of adverse reactions. Methods： 137 uterine scar pregnancy patients were divided into two groups, 45 cases in group A received traditional curettage treatment, and 45 cases in group B received the intervention of the implementation of drugs to kill the embryo and u- terus, and 47 cases in group C received implementation of hysteroscopic surgery. The operation condition and clini- cal indexes of the 3 groups were observed, and the treatment efficiency was compared. Results： Operation time and bleeding during the operation of the 3 groups had statistically significant differences between groups （ P 〈 0. 05 ） ; in the aspect of postoperative clinical indicators, vaginal bleeding days, beta - HCG level recovery time, hospitaliza- tion time and menstrual recovery time of group C were significantly shorter than these of group A and group B （ P 〈 0. 05 ） ; the total effective rate of group C was 97. 87%, which was significantly higher than that of group A （77. 78% ） and group B （80%） , P 〈 0. 05; some adverse reactions all occurred in three groups, including fever and abdominal pain. However, the incidence of adverse reactions of group C was significantly lower than these of group A and group B （ P 〈 0.05 ）. Conclusion ： Hysteroscopy in the treatment of uterine scar pregnancy after termi- nation of cesarean section has an ideal treatment effect with mild adverse reaction, which is also safe and effective.