剖宫产瘢痕妊娠两种手术方式疗效的比较

Comparison of treatment efficacies between two surgical methods for caesarean scar pregnancy

目的探讨阴式或腹腔镜剖宫产瘢痕妊娠病灶清除加子宫下段成形术治疗剖宫产瘢痕妊娠的疗效。方法150例剖宫产瘢痕妊娠患者,分为阴式手术(75例)和腹腔镜手术(75例),对比观察两组手术时间、术中出血量、肛门排气时间、总住院时间、术后住院时间、住院总费用及术后随访情况。结果两种手术方式均顺利完成,无中转开腹。阴式组手术时间、术中出血量、肛门排气时间及住院总费用均小于腹腔镜组,差异有统计学意义(P<0.05);而两组总住院时间及术后住院时间相比,差异均无统计学意义(P>0.05);术后每周复查血HCG直至正常值、观察阴道流血时间及月经恢复正常时间,两组相比,差异均无统计学意义(P>0.05);且术后两组患者的月经量均恢复正常,未出现异常情况。结论阴式及腹腔镜子宫切口妊娠病灶清除加子宫下段成形术均能治愈剖宫产瘢痕妊娠,均具有创伤小、恢复快、住院时间短、出血量少、并发症少等优点,为剖宫产瘢痕妊娠患者保留了生育功能。阴式手术在满足阴道条件的前提下,优于腹腔镜手术,但两种术式不能完全互相替代。

Objective To investigate the efficacy of vaginal or laparoscopic cesarean section scar pregnancy lesion removal and lower uterine segment plasty in the treatment of cesarean scar pregnancy.Methods One hundred and fifty patients with cesarean scar pregnancy were divided into the vaginal surgery(75 cases)and laparoscopic surgery(75 cases).The operation time,intraoperative blood loss volume,anal exhaust time,total hospitalization stay,postoperative hospitalization stay,total hospitalization cost and postoperative follow-up were observed and compared between the two groups.Results The two surgical methods were successfully completed without conversion to laparotomy.The operative time,intraoperative blood loss volume,anal exhaust time and total hospitalization expenses in the vaginal group were all smaller than those in the laparoscopic group with statistically significant differences(P<0.05).There was no statistically significant difference in total hospitalization duration and postoperative hospitalization duration between the two groups(P>0.05).There was no statistically significant difference in blood HCG detected once per week till the normal value,observed vaginal bleeding time and time recovering to normal menstruation between the two groups(P>0.05).Moreover the postoperative menstruation amount in the two groups recovered to normal without appearing the abnormal phenomenon.Conclusion Both vaginal and laparoscopic uterine incision for the removal of pregnancy lesions and lower uterine segment plasty can cure cesarean scar pregnancy,and both have the advantages of small trauma,rapid recovery,short hospitalization stay,less bleeding volume,less complications,etc.,thus preserve the fertility function for the patients with cesarean scar pregnancy.The vaginal surgery is superior to the laparoscopic surgery on the premise of meeting the vaginal conditions,but the two surgical methods could not be completely mutually replaceable.