经阴道子宫切口瘢痕妊娠手术切除的疗效观察

The clinical effect of transvaginal uterine incision in scarpregnancy resection

目的:探讨经阴道行子宫瘢痕处妊娠手术切除的临床疗效。方法:剖宫产术后子宫切口瘢痕妊娠病人25例,随机分成2组,对照组17例行子宫动脉甲氨蝶呤栓塞介入+24 h内B超监护下行清宫术,观察组8例经阴道行子宫切口瘢痕妊娠病灶切除术。比较2组的临床疗效。结果:25例病人均手术成功,痊愈出院。观察组手术时间、住院费用、术后正常月经来潮时间均低于对照组(P<0.01);术中出血量高于对照组(P<0.01);2组住院时间、术后血β-h CG恢复正常时间差异均无统计学意义(P>0.05)。术后2周复查B超显示,观察组瘢痕包块发生率0.00%,低于对照组的52.94%(P<0.05)。2组术后月经异常率差异无统计学意义(P>0.05)。结论:经阴子宫切口瘢痕妊娠病灶切除术能一次性清除病灶,微创,易于操作,手术同时能去除瘢痕处憩室,术后并发症少,值得临床推广。

Objective：To investigate the clinical effects of transvaginal uterine scarpregnancy resection. Methods：Twenty-five patients with scarpregnancy after cesarean section were randomly divided into the control group（17 cases） and observation group（8 cases）. The control group were treated with uterine artery methotrexate embolization combined with uterine curettage guilded by B-ultrasonography within 24 hours,and the observation group were treated with transvaginal uterine scarpregnancy resection. The clinical effects between two groups were compared. Results：Twenty-five patients were successfully operated and discharged. The average operation time,hospital expense and postoperative normal menstrual time in observation group were lower than those in control group（P 〈 0. 01）. The intraoperative blood loss in observation group were higher than that in control group（P〈0. 01）. The differences of the average hospital stay and postoperative blood β-hCG recovery time between two groups were not statistically significant（P〉0. 05）. The results of B ultrasound after 2 weeks of operation showed that the incidence rate of scar mass in observation group（0. 00%） was lower than that in control group（52. 94%）（P〈0. 05）. There was no statistical significance in the abnormal rate of menstruation between two groups（P〉0. 05）. Conclusions：The transvaginal uterine scarpregnancy resection can one-time remove lesions and scar diverticulum, and is minimally invasive,easy to operate and less postoperative complications,which is worthy of clinical promotion.