腹腔镜与阴式手术治疗Ⅲ型剖宫产瘢痕妊娠临床疗效观察

A comparative study on the effects of laparoscopic and transvaginal surgery on typeⅢcaesarean scar pregnancy

目的探究腹腔镜与阴式手术治疗Ⅲ型剖宫产瘢痕妊娠的疗效。方法回顾性分析大竹县人民医院2015年3月至2019年3月收治的54例Ⅲ型剖宫产瘢痕妊娠患者的临床资料。其中行腹腔镜下子宫切开取胚术的28例为腹腔镜组(A组),行经阴道子宫切开取胚术的26例为阴式手术组(B组),术后定期复查至术后6月。对比两组患者术后恢复情况。结果两组患者人绒毛膜促性腺激素下降至正常时间、月经恢复时间比较,差异无统计学意义(P>0.05)。两组患者手术时间、术中出血量、住院费用、肛门排气时间、住院时间、术后出现阴道异常流血、发生剖宫产子宫切口愈合不良等指标比较,A组数据大于B组,差异均有统计学意义(P<0.05)。两组患者术后复查瘢痕肌层厚度比较,A组小于B组,差异有统计学意义(P<0.05)。结论阴式手术治疗Ⅲ型剖宫产瘢痕妊娠较腹腔镜手术的手术时间短、出血量少,术后恢复快,住院费用低,且术后发生阴道异常流血、切口憩室形成的比例低,瘢痕愈合更好,更有临床优势。

Objective To compare the effect of laparoscopic and transvaginal surgery on typeⅢcesarean scar pregnancy.Methods A retrospective analysis of the clinical data of 54 patients with typeⅢcaesarean scar pregnancy treated in Dazhu County People's Hospital from March 2015 to March 2019.Among them,28 cases underwent laparoscopic uterine cystectomy and suture were in laparoscopic group(Group A),26 cases underwent transvaginal uterine cystectomy and suture were in vaginal operation group(Group B),regular postoperative reviewed to 6 months after surgery.Compared the postoperative recovery of the two groups of patients.Results There were no significant differences between the two groups of patients with hCG dropping to normal time and menstrual recovery time(P>0.05).In the two groups,there were significant differences in the general indicators such as surgical time,intraoperative bleeding,hospitalization cost,anal exhaust time,hospitalization time,and whether there was abnormal vaginal bleeding after surgery,whether there was bad uterine incision healing after cesarean section,etc.,datas of Group A were significantly larger than Group B,the differences were statistically significant(P<0.05).The thickness of the scar muscular layer after re-examination in group A was significantly smaller than that in group B,with a significant difference(P<0.05).Conclusion Vaginal surgery for typeⅢcesarean scar pregnancy has shorter operation time,less bleeding,faster postoperative recovery,lower hospitalization cost,lower vaginal bleeding after surgery,lower rate of incision diverticulum formation,and better scar healing than laparoscopic surgery,with clinical advantages.