宫腔镜病灶切除术对内生型剖宫产瘢痕妊娠患者术后生活质量及并发症发生率的影响

Effect of hysteroscopic resection of lesions on postoperative quality of life and complication rate in patients with endogenous type cesarean scar pregnancy

目的研究宫腔镜病灶切除术对内生型剖宫产瘢痕妊娠（CSP）患者术后生活质量及并发症发生率的影响。方法选取2015年5月至2017年1月本院收治的89例内生型CSP患者作为研究对象，按随机数字表法分组。对照组44例采用腹腔镜手术治疗，观察组45例采用宫腔镜病灶切除术治疗。对比丽组手术前后生活质量（GQOLI-74）评分变化、围手术期指标[术中出血量、手术时长、宫腔引流量、月经恢复时间、住院天数、血清β-人绒毛膜促性腺激素（血清β-HCG）恢复正常时间]及不良反应（阴道出血、发热、包块残余、下腹疼痛、下肢静脉血栓）发生状况。结果术前两组GQOLI-74评分比较差异无统计学意义（P〉0．05）；术后观察组GQOLI-74评分高于对照组，差异有统计学意义（P〈0．05）；两组宫腔引流量、血清B—HCG恢复正常时间比较差异无统计学意义（P〉0．05）；观察组术中出血量、手术时长、月经恢复时间、住院天数低于对照组，差异有统计学意义（P〈0．05）；观察组并发症发生率为8．89％（4／45）低于对照组的27．27％（12／44），差异有统计学意义（P〈0．05）。结论内生型CSP患者采用宫腔镜病灶切除术治疗，可缩短手术时间，减少术中出血量，加快患者康复，提高生活质量，降低并发症发生率，安全性较高。

Objective To study the effect of hysteroscopic resection of lesions on postoperative quality of life and complication rate in patients with endogenous type cesarean scar pregnancy （CSP）. Methods 89 cases of patients with endogenous type CSP in our hospital from May 2015 to January 2017 were selected as the research object and were grouped according to the random number table. 44 cases in the control group received laparoscopic surgery, while 45 cases in the observation group received hysteroscopic resection of lesions. Compared the quality of life （GQOLI-74 score） before and after surgery, perioperative indexes （intraoperative bleeding volume, operation time, uterine cavity drainage volume, menstrual recovery time, hospitalization day, time of serum β-HCG returning to normal） and adverse reactions （vaginal bleeding, fever, residual mass, abdominal pain, lower extremity venous thrombosis） of the two groups. Results There was no statistically significant difference in GQOLI-74 score between the two groups before operation （P〉0.05）; the score of GQOLI-74 in the observation group was higher than that in the control group after operation （P〈0.05）. There were no statistically significant differences in uterine cavity drainage volume and time of serum β-HCG returning to normal between the two groups （P〉0.05）. The intraoperative bleeding volume, operation time, menstrual recovery time, hospitalization day in the observation group were less than those in the control group （P〈0.05）. The incidence of complications in the observation group was 8.89% （4/45）, lower than that in the control group [27.27% （12/44）] （P〈0.05）. Conclusion Hysteroscopic resection of lesions for patients with endogenous type CSP can reduce the operation time, the amount of intraoperative blood loss, speed up the rehabilitation of patients, improve the quality of life, and reduce the incidence of complications, with higher safety.