宫腔镜联合水囊压迫法治疗剖宫产瘢痕部位妊娠患者32例疗效观察及术后随访研究

Clinical observation and follow-up study of hysteroscopy combined with cystic oppression treatment for 32 cases of cesarean scar pregnancy

目的:探讨宫腔镜联合水囊压迫法治疗剖宫产瘢痕部位妊娠(CSP)的临床效果。方法:选取2014年1月至2017年2月延安大学附属医院诊治的64例CSP患者为研究对象,按照随机数表法将其分为观察组与对照组,每组32例患者。观察组患者行宫腔镜联合水囊压迫法治疗,对照组患者行B超引导下清宫术治疗。比较两组患者手术及术后恢复情况[手术用时、术后出血量、血人绒毛膜促性腺激素(HCG)、恢复正常时间及住院时间]、术后并发症发生率;随访3个月,比较两组患者手术前及术后3个月生活质量评分。结果:(1)手术及术后恢复情况:与对照组比较,观察组患者手术用时短、术后出血少、血HCG恢复正常时间早,且住院时间短,其差异具有统计学意义(P <0. 05)。(2)并发症:观察组患者术后并发症发生率[6. 3%(2/32)]低于对照组患者[28. 1%(9/32)],其差异具有统计学意义(P <0. 05)。(3)生活质量:两组患者手术前生活质量评分比较,其差异无统计学意义(P> 0. 05);术后随访3个月,观察组患者生活质量评分高于对照组患者,其差异具有统计学意义(P <0. 05)。结论:给予CSP宫腔镜联合水囊压迫法治疗剖宫产瘢痕部位妊娠患者,可以取得显著疗效,且手术用时短、术后出血少、并发症发生率低,有利于术后生活质量改善。

Objective:To investigate the clinical effect of hysteroscopy combined with balloon compression in the treatment of cesarean section pregnancy(CSP).Methods:64 CSP patients from January 2014 to February 2017 in The Hospital Affiliated to Yan′an University were selected.They were randomly divided into observation group(n=32)and control group(n=32).The control group was treated with ultrasound guided curettage,and the observation group was treated with hysteroscopy combined with cystic oppression.The time of operation,the amount of bleeding after operation,time of human chorionic gonadotropin(HCG)returning to normal level,hospital stay,and the incidence of postoperative complications were compared between the two groups.After 3 months of follow-up,quality of life scores were compared between the two groups before and after the operation.Results:Compared with control group,the observation group had shorter operation time,less postoperative bleeding and shorter time of human chorionic gonadotropin(HCG)returning to normal level and shorter hospitalization time,all with statistically significant differences(P<0.05).The incidence of postoperative complications in observation group(6.3%,2/32)was lower than that of control group(28.1%,9/32),with statistically significant difference(P<0.05).There was no significant difference in the quality of life score between the two groups before operation(P>0.05).After 3 months of follow-up,the quality of life score of observation group was higher than that of control group,with statistically significant difference(P<0.05).Conclusions:The treatment of hysteroscopy combined with cystic oppression can achieve significant effect.With shorter operation time,less postoperative bleeding and lower complication rate,it is beneficial to the improvement of postoperative quality of life.