剖宫产瘢痕妊娠142例临床分析

Clinical analysis on 142 cases with cesarean scar pregnancy

目的探讨不同治疗方法对剖宫产瘢痕妊娠疗效的影响。方法收集符合剖宫产瘢痕妊娠诊断标准的142例患者的临床资料进行回顾性分析。根据治疗方法分为4组,A组为清宫组75例,B组为宫腔镜下瘢痕妊娠病灶电切术组12例,C组为瘢痕妊娠病灶切除术38例,D组为药物保守治疗组17例。比较各组不同类型瘢痕妊娠的例数以及术中出血量、手术时间、住院时间。结果 A组有62例为Ⅰ型剖宫产瘢痕妊娠,13例为Ⅱ型;B组有9例为Ⅰ型剖宫产瘢痕妊娠,3例为Ⅱ型;C组有20例为Ⅰ型,18例为Ⅱ型;D组有16例为Ⅰ型,1例为Ⅱ型。其中C组中Ⅱ型的病例数明显多于其他各组(P<0.05),而D组的Ⅰ型病例多于其他组(P<0.05)。B组的出血量(29.17±34.23)mL及手术时间(22.50±5.44)min,均少于A、C组(P<0.05)。各组间的住院时间比较差异无统计学意义(P>0.05)。结论对剖宫产瘢痕妊娠需采取个体化治疗方案,对于Ⅰ型,传统清宫术易于实施,应用广泛。而宫腔镜下病灶电切术相对于清宫术具有恢复快、安全性高等优点,值得临床推广;Ⅱ型患者行瘢痕妊娠病灶切除术治疗效果显著。

Objective To investigate treatment of caesarean scar pregnancy （CSP） and associated problem. Methods 142 cases with CSP undergoing treatment in General Hospital of Ningxia Medical University were retrospectively studied Methods 144 Patients were divided into 4 groups, and 75 cases treated by curettage （ group A）, 12 cases treated by pregnancy tissue resection under hysterosco- py （group B） ,38 cases treated by CSP debridement （group C ）, and 17 cases treated by medical therapy （group D）. The operative time,intraoperative blood loss volume, postoperative hospital stay was compared between the 4 groups. Results Group A：62 cases were type I and 13 cases type II. Group B：9 cases were type I and 3 cases type Ⅱ. Group C：20 cases were type I and 18 cases type II. Group D： 16 cases were type I and 1 cases type II. The quantity of type II in group C was more than others,secondly was group A （P 〈0.05）. The quantity of type I in group D was more than others,secondly was in group A （P 〈 0.05 ）. The intraoperative blood loss （29.17±34.23）mL and operation time （22.50±5.44） min of group B were more less than those in other groups （P 〈0.05）. But there were no statistically significant differences in hospital stay. Conelttslon For type I, curettage is easy to operate with widespread use. But terosco- pie surgery is worth of being generalized ,which showed less damage and rapid postoperative. For type II, CSP debridement is feasible and effective.