微创手术治疗子宫瘢痕妊娠对再次妊娠结局的影响及意义

Effect of minimally invasive surgery for cesarean scar pregnancy on repregnancy outcome and its significance

目的研究微创手术治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床效果,分析其对孕妇再次妊娠结局的影响。方法选取150例CSP患者为研究对象,按照治疗手段的不同将其分为三组,每组50例,A组行腹腔镜下CSP病灶清除及修补术,B组行阴式CSP病灶清除及修补术,C组行清宫术。对比分析三组CSP患者的手术时间、术中出血量、月经复潮时间、总住院费用、住院时间、并发症发生率、术后半年超声检查情况以及三组患者再次妊娠结局。结果 3组手术时间、术中出血量、总住院费用及住院时间比较,差异均有统计学意义(P<0.05),其中手术时间及总住院费用:A组>B组>C组;术中出血量及住院时间:C组>A组>B组。3组患者月经复潮时间比较,差异无统计学意义(P>0.05)。B组并发症发生率为4.00%,明显低于A组的26.00%、C组的38.00%(P<0.05)。术后6个月超声检查提示A组、B组切口处厚度明显优于C组。3组自然分娩率、剖宫产率、正常妊娠状态、再次子宫瘢痕妊娠率、稽留流产率及输卵管妊娠率比较,差异无统计学意义(P>0.05)。C组未妊娠率明显低于A组、B组(P<0.05);A组、B组未妊娠率比较,差异无统计学意义(P>0.05)。结论临床中可将腹腔镜及阴式CSP病灶清除及修补术作为治疗子宫瘢痕妊娠的优选方案,对于阴道条件好者,可首选阴式CSP病灶清除及修补术,其具有恢复时间更短、切口愈合更佳、术后再次妊娠时发生CSP的概率更低的优势。

Objective To study the clinical efficacy of minimally invasive surgery for cesarean scar pregnancy （CSP） and to analyze its effect on the repregnancy outcome. Methods A total of 150 patients with CSP were selected, and were divided into three groups（with 50 cases in each group） according to the treatment methods. Group A underwent laparoscopic debridement and repair for CSP lesions, group B underwent transvaginal debridement and repair for CSP lesion, and group C underwent curettage. The related indices were compared among the three groups, including operation duration, intraoperative blood loss, duration for menstrual onset, total hospitalization cost, hospital stay, incidence of complications, ultrasound examination results at postoperative six months and repregnancy outcome. Results There were significant differences in the operation duration, intraoperative blood loss, total hospitalization cost and hospital stay among the three groups（ P 〈0.05）. The operation duration and total hospitalization cost decreased in the order of group A, group B and group C. The intraoperative blood loss and hospital stay decreased in the order of group C, group B and group A. There was no significant difference in the duration for menstrual onset among the three groups（ P 〉0.05）. The incident rate of the complications of group B was significantly lower than that of group A or group C （4.00%, 26.00% and 38.00% respectively, P 〈0.05）. At 6 months after operation, the ultrasound examination showed that the thickness at the incision of group A or group B was superior to that of group C. There were no significant differences in the spontaneous labor rate, cesarean rate, normal pregnancy , CSP rate, missed abortion rate and fallopian pregnancy rate among the three groups（ P 〉0.05）. The failure rate of pregnancy in group C was significantly lower than that in group A or group B（ P 〈0.05）, but there was no significant difference in the failure rate of pregnancy between group A and group B（ P 〉0.05 ）. Conclusion Both laparoscopic and transvaginal debridement and repair for CSP lesions can be used as the optimal clinical treatment for CSP. Transvaginal debridement and repair for CSP lesions has the advantages of shorter recovery time, better incision healing, lower risk of CSP during next pregnancy, and is the first choice for the cases with good vaginal conditions.