多次宫腔镜手术及宫腹腔镜联合手术对于Ⅲ型剖宫产瘢痕妊娠的治疗效果分析

Treatment effectiveness of repeated hysteroscopy and hysteroscopy combined with laparoscopy on Type Ⅲ cesarean scar pregnancy

目的比较多次宫腔镜及宫腹腔镜联合手术应用于Ⅲ型剖宫产瘢痕妊娠(CSP)患者的治疗效果。方法回顾性分析我院2012年12月至2016年6月确诊CSP患者的临床资料,选择其中Ⅲ型患者共41例,根据手术方式的不同分为两组:A组(20例)先后行两次宫腔镜CSP病灶切除术;B组(21例)行宫腔镜探查术+腹腔镜CSP病灶切除术+子宫修补术。比较两组患者手术情况、手术成功率、术后恢复情况及再次妊娠结局。结果与A组相比,B组累积手术时间显著延长[(71.2±9.5)min vs.(59.2±6.9)min](P<0.05),月经恢复时间[(32.1±4.6)d vs.(39.3±6.8)d]及术后血HCG下降至正常范围时间[(27.3±5.1)d vs.(34.7±5.6)d]显著缩短(P均<0.05)。两组患者的术中出血量、并发症发生情况、手术成功率等比较均无显著性差异(P>0.05)。两组共随访到7例患者再次妊娠,均无再次CSP发生。结论多次宫腔镜手术及宫腹腔镜联合手术对于Ⅲ型CSP患者均有很好的治疗效果,在临床中可以根据患者具体情况选择合适的手术方案。

Objective： To explore the clinical treatment effect of repeated hysteroscopy and hysteroscopy combined with laparoscopy on TypeⅢ cesarean scar pregnancy（CSP）.Methods： Forty one patients diagnosed as Type Ⅲ CSP in Shengjing Hospital affiliated to China Medical University from December 2012 to June 2016 were included in the study.The patients were divided into two groups：the patients were treated by repeated hysteroscopic CSP resection in Group A（n=20）,and the patients were treated by hysteroscopic combined with laparoscopic CSP resection and uterine repair in Group B（n=21）.The operation status,operation success rate,postoperative recovery and repregnancy were compared between the two groups.Results： The accumulated operation time in Group B was significantly longer than that in Group A[（71.2±9.5）vs.（59.2±6.9）min]（P0.05）.The time of menstruation recovery in Group B was significantly shorter than that in Group A [（32.1±4.6）vs.（39.3±6.8）days]（P0.05）,and the time of HCG descending to normal level in Group B was significantly shorter than that in Group A [（27.3±5.1）vs.（34.7±5.6）days ]（P0.05）.There was no significant differences in bleeding volume,operation complication and success rate between the two groups（P0.05）.Seven patients were re-pregnancy during followed-up in the two groups,and no recurrence of CSP occurred.Conclusions： Both repeated hysteroscopy and hysteroscopy combined with laparoscopy can be used for treatment of TypeⅢ cesarean scar pregnancy.In clinical practice,appropriate surgical options can be selected according to the patient＇s condition.