104例剖宫产瘢痕妊娠两种手术治疗的临床分析

The clinical analysis of two surgical treatments of 104 cases of cesarean scar pregnancy

目的探讨刮宫术和经阴道子宫瘢痕妊娠病灶切除术及子宫修补术两种手术方式治疗剖宫产瘢痕妊娠的效果。方法回顾性分析2016年1月至2017年4月南京医科大学附属妇产医院收治的104例剖宫产瘢痕妊娠患者的临床资料，所有患者均先行双侧子宫动脉灌注栓塞治疗，再按照不同手术方式分为A组：刮宫术，B组：经阴道子宫瘢痕妊娠病灶切除术及子宫修补术。分析两组术中出血量、手术时间、住院时间、住院费用、术后血13-hCG下降幅度及疗效。结果B组术中出血量少、术后血8-hCG下降幅度大，较A组有显著差异（P〈0．05），B组较A组手术时间稍长I差异有统计学意义（P〈0．05），住院时间和住院费用无明显差别（P〉0．05）。B组治疗均成功，A组有两例失败，治疗有效率差异无统计学意义（P〉0．05）。结论子宫动脉灌注栓塞治疗后行经阴道子宫瘢痕妊娠病灶切除术及子宫修补术安全有效，具有出血少、术后恢复快优点，值得临床推广。

Objective To investigate the efficiency of curettage compared with transvaginal local lesion resection and repair of uterine defect for cesarean scar pregnancy （CSP） . Methods A retrospective analysis of 104 cases of CSP patients aeated in our hospital from January 2016 to April 2017. All the patients were first treated with bilateral uterine artery perfusion embelization , and then were divided into two operation groups ：ihe curettage （group A）; the transvaginal local lesion resection and repair of uterine defect （group B）.The operative blood loss, operative time, hospitalization days, hospitalization costs, postoperative serum [β-HCG decrease and curative effect were collected and analyzed. Results The operative blood loss in group B were lower than group A. （P 〈 0.05 ） . The postoperative serum 13-hCG decrease were higher than group A （P〈 0.05 ） . But group B had longer operation time than group A （P 〈 0.05） . The hospitalization time and hospitalization costs have no obvious difference between two groups （P〉0.05） . The cases in group B were all successful. There were two cases failed in group A. But there was no significant difference in treatment efficiency between two groups （P 〉 0.05） . Conclusions The transvaginal local lesion resection and repair of uterine defect for CSP is safe, effective, less bleeding, faster recovery for patients. It is worthy of clinical promotion.