不同术式对剖宫产瘢痕妊娠及瘢痕类型的影响

Effects of different operation methods on cesarean scar pregnancy and types of scar

目的分析剖宫产瘢痕妊娠不同手术的围术期差异及对瘢痕妊娠的影响。方法回顾性分析2012年8月-2015年8月内江市第一人民医院197例剖宫产瘢痕妊娠患者为临床资料,根据手术类型将以上患者分为4组,A组54例(宫腔镜电切术)、B组55例(清宫术)、C组52例(阴式病灶切除术)、D组36例(腹部病灶清除术),组内另分为内生型和外生型。比较各组手术时间、手术出血量、住院时间差异,检测术后1个月内不同时点β-h CG变化及β-h CG恢复正常时间,另外观察4组术后二次处理率。结果 A组内生型手术出血量低于外生型(P<0.05),B组内生型出血量低于外生型(P<0.05),C组、D组内生型、外生型各指标比较差异无统计学意义(P>0.05);内生型手术出血量C组高于其他3组,手术时间C组长于其他3组(P=0.000),手术时间C组显著高于其他3组(P=0.000),住院时间D组显著高于其他3组(P=0.039)。各组外生型比较,4组手术出血量比较差异无统计学意义(P=0.870),手术时间C组、D组显著高于A组、B组(P=0.000),住院时间4组比较差异无统计学意义(P=0.659)。4组β-h CG降至正常值时间比较差异无统计学意义(P>0.05),术后各组β-h CG较前一时点均显著降低(P<0.05)。术后二次处理率6.09%,内生型2.17%,外生型9.52%。A组二次处理5例,其中内生型1例;B组二次处理6例,其中内生型1例;C组1例外生型因出血过多摘除子宫;D组无二次处理者。结论内生型、外生型瘢痕妊娠手术情况存在较大差异,宫腔镜手术较适用于内生型治疗,阴式病灶切除术及腹部病灶清除术可用于外生型治疗。

Objective To analyze the differences of different operation methods of cesarean scar pregnancy （CSP） during perioperative period and the influence on CSP.Methods The clinical data of 197 patients with CSP treated in the First People＆#39;s Hospital of Neijiang from August 2012 to August 2015 were analyzed retrospectively.According to the types of operation,the patients were divided into A group （hysteroscopic electrocision,54 patients）,B group （uterine curettage,55 patients）,C group （transvaginal lesionectomy,52 patients）,and D group （transabdominal debridement,36 patients）,and the patients in each group were divided into endogenous type and exogenous type.The operation time,the amounts of blood loss during operation,the hospitalization time in the four groups were compared.The changes of β-human chorionic gonadotropin （β-hCG） at different time points within one month after treatment and the time of β-hCG return to normal were detected.The rates of secondary treatment in the four groups were observed.Results In A group and B group,the amounts of blood loss during operation among patients of endogenous type were statistically significantly lower than those of exogenous type （P〈0.05）.In C group and D group,there was no statistically significant difference between endogenous type and exogenous type （P〉0.05）.Among the patients of endogenous type,the amount of blood loss during operation in C group was statistically significantly higher than those in the other three groups,the operation time in C group was statistically significantly longer than that in the other three groups （P=0.000）,the hospitalization time in D group was statistically significantly higher than that in the other three groups （P =0.039）.Among the patients of exogenous type,there was no statistically significant difference in the amount of blood loss during operation among the four groups （P =0.870）,the operation time in C group and D group was statistically significantly longer than that in A group and B group （P=0.000）,there was no statistically significant difference in hospitalization time among the four groups （P=0.659）.There was no statistically significant difference in the time of β-hCG return to normal among the four groups （P〉0.05）.The levels of serum β-hCG after treatment were statistically significantly lower than those before treatment in the four groups （P〈0.05）.The rate of secondary treatment was 6.09%.The rates of secondary treatment among patients of endogenous type and exogenous type were 2.17% and 9.52%,respectively.In A group,five patients received secondary treatment,including one patient of endogenous type;in B group,six patients received secondary treatment,including one patient of endogenous type;in C group,uterus was removed in one patient of exogenous type due to massive bleeding;in D group,no patient received secondary treatment.Conclusion There are great differences between endogenous type and exogenous type in CSP operation.Hysteroscopic electrocision is suitable for treatment of endogenous type,while transvaginal lesionectomy and transabdominal debridement are suitable for treatment of exogenous type.