子宫瘢痕妊娠的临床特征及两种手术方法对预后的影响

Clinical characteristics of cesareen scar pregnancy and the effects of two surgical treatments onprognosis

目的 探讨经宫腔检查镜引导下实施清宫术与宫腹腔镜联合术对子宫瘢痕妊娠（CSP）的预后影响.方法 选取需手术治疗的CSP患者136例,根据治疗方法分为对照组与实验组;对照组采用宫腔镜引导下清宫术治疗,实验组采用宫腹腔镜联合术治疗.比较两组 β-人绒毛膜促性腺激素（β-HCG）转阴时间、月经来潮时间、阴道流血时间、住院天数;分析两组治疗有效率;分析两组治疗方法的安全性（包括休克、疼痛、感染）.结果 对照组β-HCG转阴时间、月经来潮时间、阴道流血时间均长于与实验组（t=10.375,P=0.001;t=13.761,P=0.001;t=5.392,P=0.022）.实验组总有效率[94.1％（64/68）]高于对照组[76.4％（52/68）],差异有统计学意义（χ2=9.266,P=0.005）.实验组不良反应总发生率[10.2％（7/68）]低于对照组[42.6％（29/68）],差异有统计学意义（χ2=10.214,P=0.002）.结论 宫腹腔镜联合术治疗CSP疗效显著,较宫腔镜引导下清宫术更可靠、安全,且有利于预后康复,值得推广应用.

Objective To investigate the effects of hysteroscopic uterine curettage and hysteros-copy combined with laparoscopy surgery on cesareen scar pregnancy （CSP） and on the prognosis. Methods A total of 136 patients who has to undergo operation due to CSP were selected and were grouped according to treatment protocols; control group were given hysteroscopic uterine curettage treat-ment, experimental group were given hysteroscopy combined with laparoscopy surgery. β-HCG clearance time, menstruation time, vaginal bleeding time and hospital stay were compared between the two groups; and treatment efficiency and safety （including shock, pain, infection） were compared between the two groups. Results Compared with experimental group, β-HCG negative time (t = 10. 375, P = 0. 001), menstruation time （t = 13.761 ,P =0. 001), vaginal bleeding time （t =5. 392 ,P =0. 022） of patients in control group were longer. The total effective rate of experimental group [ 94. 1% （66/68） ] was higher than that of control group [ 76.4% (52/68) ], the different was significant (X2 = 9.266, P = 0. 005). The total incidence of adverse reactions in experimental group [ 10.2% （7/68） ] was lower than that in eontrol group [42.6% （29/68）], and the difference between the two groups was statistically significant （X2 = 10. 214,P =0. 002）. Conclusions Compared with simple hysteroscopic uterine curettage, hysteroscopy eombined with laparoseopy surgery has significant curative effects on CSP, which is more reliable and safe and is conducive to the rehabilitation and improve prognosis, so it is worthy of popularization and applieation.