Ⅱ~Ⅲ型剖宫产瘢痕妊娠病灶经腹腔镜和经阴道切除术治疗效果比较

Comparison of the effect of laparoscopic and transvaginal lesion resection ectomy in treament of type II-III cesarean scar pregnancy

目的:分析经腹腔镜和经阴道瘢痕妊娠病灶切除术治疗II-III型剖宫产瘢痕妊娠(CSP)的临床效果。方法:回顾性收集2015年1月—2019年11月在本院手术治疗的II-III型CSP患者76例临床资料,其中腹腔镜下瘢痕妊娠病灶切除术44例为腹腔镜组,经阴道瘢痕妊娠病灶切除术32例为经阴道组,比较两组手术疗效。结果:两组在术中出血量、住院时间、月经恢复正常时间、术后第1dβ-hCG下降幅度>入院基础值的50%患者比例、β-hCG降至正常时间以及围术期并发症比较无差异(P>0.05);经阴道组手术时间(63.1±20.1min)较腹腔镜组(76.5±11.6min)短,住院费用(8573±2416元)较腹腔镜组(12088±1231元)低,术后子宫下段肌层厚度(15.2±1.1mm)较腹腔镜组(14.1±1.0mm)厚(P<0.05)。结论:经腹腔镜或经阴道剖宫产瘢痕妊娠病灶切除术治疗II-III型CSP均疗效均确切,安全性良好,经阴道手术花费少、手术时间短,术后子宫下段肌层厚度更厚。

Objective: To analyze the clinical effect of laparoscopic and transvaginal cesarean scar pregnancy(CSP) lesion resection for treating women with type II-III CSP. Methods: The clinical data of 76 women with type II-III CSP from January 2015 to November 2019 were collected retrospectively. Among them, 44 women were treated with laparoscopic CSP lesion excision(group A) and 32 women were treated with transvaginal CSP lesion excision(group B). The operative effect of the women was compared between the two groups. Results: There were no significant differences in the intraoperative blood loss, time of hospital stay, the time of menstruation recovery, the rate of the women with β-HCG level decreased over 50% on the first postoperative day, the time of β-HCG level returned to normal, and the rate of perioperative complication of the women between the two groups(P>0.05). The operative time(63.1±20.1 min) of the women in group B was significant shorter than that(76.5±11.6 min) of the women in group A, the hospitalization cost(8573±2416 Yuan) of the women in group B was significant lower than that(12088±1231 Yuan) of the women in group A, and the postoperative muscular thickness of the lower uterine segment(15.2±1.1 mm) of the women in group B was significant was thicker than that(14.1±1.0 mm) of the women in group A(P<0.05). Conclusion: Both laparoscopic and transvaginal CSP lesion resection for treating women with type II-III CSP have definite curative effect with good safety, but transvaginal CSP lesion resection has certain advantages in terms of less hospitalization costs, shorter operation time, and thicker postoperative muscular thickness of lower uterine segment.