经阴道及腹腔镜治疗Ⅲ型剖宫产瘢痕妊娠的临床分析

Clinical Effect of Transvaginal and Laparoscopic Surgery for Cesarean Scar Pregnancy with Type Ⅲ

目的比较经阴道及腹腔镜手术路径治疗剖宫产瘢痕妊娠的有效性及安全性。方法回顾性分析2018年1月~12月我院妇产科收治的75例Ⅲ型剖宫产瘢痕妊娠患者的临床资料。按照手术路径分为两组:阴式手术组40例,采用经阴道子宫瘢痕妊娠病灶切除术+子宫修补术;腹腔镜手术组35例,采用腹腔镜瘢痕妊娠病灶切除术+子宫修补术。比较两组围手术期指标及术后并发症情况。结果两组患者手术均顺利完成,无中转开腹手术。阴式手术组术中出血量少于腹腔镜组,手术时间、术后恢复排气时间和住院时间均短于腹腔镜组,术后24 h疼痛评分和住院费用均低于腹腔镜组,差异均有统计学意义(P<0.05)。两组月经恢复时间比较,差异无统计学意义(P>0.05)。阴式手术组术后无并发症发生,腹腔镜手术组发热2例、尿潴留1例;两组并发症发生率比较,差异无统计学意义(P>0.05)。结论经阴道子宫瘢痕妊娠病灶切除术具有疗效确切、止血效果好、手术快捷、术后恢复快、治疗周期短、费用低的优势,值得临床积极推广。

Objective To compare the efficacy and safety of transvaginal surgery and laparoscopic surgery in the treatment of cesarean scar pregnancy with typeⅢ.Methods A retrospective analysis was performed on 75 cases of exogenous cesarean scar pregnancy(CSP)with typeⅢin the department of obstetrics and gynecology of our hospital from January to December 2018.According to the surgical approach,75 cases were divided into two groups:40 cases as the transvaginal group were performed CSP lesion resection and uterine neoplasty via vagina,and 35 cases as the laparoscopic group were carried out CSP lesion resection and uterine neoplasty under laparoscope.The operation time,intra-operative blood loss,postoperative pain degree,exhaust recovery time,post-operative hospital stays,hospital charges,menstruation recovery time,complications and other clinical indicators were compared between the two groups.Results The operation was successfully completed in both groups without conversion to open surgery.The intra-operative blood loss,operation time,exhaust recovery time,hospital stays,hospital cost and pain score at 24 h after the surgery was less in the vaginal group than those in the laparosopic group,and all the differences were significant statistically(P<0.05).There was no statistical difference in menstruation recovery time between the two groups(P>0.05).No complication was found in the vaginal group,but fever of 2 cases and urinary retention of one case occurred in the laparoscopic group,and there was no statistical difference in the complication rate between the two groups(P>0.05).Conclusion The lesion resection and uterus neoplasty can achieve reliable effect,effective hemostasis,fast recovery,short treatment period and low cost,and is worthy of clinical popularization.