外生型(Ⅱ型)疤痕妊娠两种手术方式的疗效比较

Analysis of the Clinical effect of two different surgical methods for exogenous cesarean scar pregnancy

目的:对外生型(Ⅱ型)疤痕妊娠(cesarean scar pregnancy,CSP)的两种不同手术方式进行分析比较。方法:选取2015年1月至2017年1月收治的60例外生型(Ⅱ型)CSP患者,根据采用的手术方式不同分为两组。A组患者采用阴式手术,B组患者采用腹腔镜手术。结果:手术均顺利完成。两组患者术后第3 d血清β-HCG下降程度比较,差异无统计学意义(P>0.05);两组患者手术时间、术中出血量及住院花费等比较,差异均有统计学意义(P<0.05)。两组患者中共有25例患者术前行子宫动脉栓塞术(uterine artery embolization,UAE),其术中出血量低于未行UAE的患者(P<0.05)。结论:治疗子宫疤痕妊娠时,应根据其分型、患者意愿及医院设施等,采取最优化治疗方案;对于外生型CSP,阴式手术具有安全、有效、费用低等优势,值得临床推广。

Objective：To compare two different surgical methods for the treatment of exogenous cesarean scar pregnancy（CSP）. Methods：60 cases of exogenous CSP were admitted from January 2015 to January 2017. Among 60 patients, 30 cases were treated by transvaginal cesarean scar pregnancy debridement surgery （group A） and 30 cases received laparoscopic caesarean section of the scar site pregnancy excision and scar repair （group B）. Results：The surgery of all patients in the two groups was completed successfully. There was no statistical difference between the two groups in the decrease of 13 - HCG in 3 days after operation （ P 〉 0.05 ）, while there were statistical differences between the two groups in the operation time, intraoperative blood loss and hospitalization expenses （ P 〈 0.05 ）. There were 25 cases of preoperative uterine artery embolization （UAE） in the two groups, and compared with those in non - UAE cases, intraoperative blood loss in UAE cases was significantly lower, the difference statistically significant （ P 〈 0.05 ） Conclusion： In the treatment of CSP, the optimal treatment plan should be adopted according to the clas- sification of CSP, patients＇will and the specific situation of the hospital facilities. For exogenous CSP, transvaginal cesarean scar pregnancy de- bridement surgery has the advantage of being safe and effective with low cost, which is worth clinical promotion.