宫、腹腔镜联合治疗外生型瘢痕妊娠后子宫内膜恢复程度及远期妊娠结局观察

Observation on endometrial recovery after the treatment of ectogenic scar pregnancy by hysteroscopy and laparoscopy and its long-term pregnancy outcome

目的观察分析宫、腹腔经联合治疗外生型瘢痕妊娠后子宫内膜恢复程度及远期妊娠结局情况。方法 50例外生型瘢痕妊娠患者作为研究对象,根据数字随机列表法分为对比组和研究组,每组25例。对比组患者采用甲氨蝶呤注射及清宫术联合治疗,研究组患者行宫、腹腔镜联合治疗。比较两组的手术指标、人绒毛膜促性腺激素(HCG)转阴时间;术后瘢痕形态与残余肌层;不良妊娠结局发生情况。结果研究组患者的HCG转阴时间(21.2±5.4)d、住院时间(6.1±2.6)d、阴道流血时间(8.0±1.2)d和月经恢复正常时间(25.0±2.6)d均明显短于对比组的(24.6±4.3)、(8.4±2.2)、(10.3±1.3)、(29.0±4.2)d,出血量(87.4±33.5)ml少于对比组的(234.0±99.3)ml,差异均具有统计学意义(P<0.05)。研究组患者的残余肌层厚度、比例均高于对比组,瘢痕宽度、长度和深度均明显低于对比组,差异均具有统计学意义(P<0.05)。研究组患者的不良妊娠结局发生率为12.00%,明显低于对比组的44.00%,差异具有统计学意义(P<0.05)。结论外生型瘢痕妊娠患者行宫、腹腔镜联合治疗,能取得较好治疗效果,加快子宫内膜与瘢痕愈合,而且还能有效改善远期妊娠结局。

Objective To observe and analyze the endometrial recovery after the treatment of ectogenic scar pregnancy by hysteroscopy and laparoscopy and its long-term pregnancy outcome. Methods A total of 50 ectogenic scar pregnancy patients as study subjects were divided into control group and research group by random number table method, with 25 cases in each group. The control group received methotrexate injection and curettage for treatment, and the research group received hysteroscopy and laparoscopy for treatment. Comparison was made on surgical indicators, negative-conversion time of human chorionic gonadotropin(hCG), scar morphology and residual myometrium after operation, and occurrence of adverse pregnancy outcomes between the two groups. Results The negative-conversion time of HCG, hospitalization time, vaginal hemorrhage time and menstruation back to normal time were(21.2±5.4),(6.1±2.6),(8.0±1.2) and(25.0±2.6) d in the research group, which was obviously shorter than(24.6±4.3),(8.4±2.2),(10.3±1.3) and(29.0±4.2) d in the control group, and amount of hemorrhage(87.4±33.5) ml was less than(234.0±99.3) ml in the control group. Their difference was statistically significant(P<0.05). The thickness and proportion of myometrium in the research group was higher than those in the control group, and scar width, length and depth was obviously lower than those in the control group. Their difference was statistically significant(P<0.05). The incidence of adverse pregnancy outcome was 12.00% in the research group, which was obviously lower than 44.00% in the control group, and the difference was statistically significant(P<0.05). Conclusion The combination of hysteroscopy and laparoscopy shows better therapeutic effect for patients with ectogenic scar pregnancy, and it can accelerate the healing of endometrium and scar, and improve the long-term pregnancy outcome.