宫腔镜手术和腹腔镜手术治疗Ⅱ型瘢痕妊娠的比较

Comparison of hysteroscopic surgery and laparoscopic surgery in the treatment of typeⅡscar pregnancy

目的探究与分析宫腔镜手术和腹腔镜手术治疗Ⅱ型瘢痕妊娠的临床效果。方法选择2016年1月—2019年1月本院收治的Ⅱ型子宫瘢痕妊娠患者100例作为研究对象,按照不同手术方法分为宫腔镜组与腹腔镜组两组,每组各50例。对比两组围手术期指标、术后恢复情况及术后并发症发生率、随访1年的再次妊娠率及再次瘢痕妊娠率。结果宫腔镜组与腹腔镜组相比手术时间较短、手术失血量较少,组间差异具有统计学意义(P<0.05)。两组相比术后引流量无明显差异(P>0.05)。宫腔镜组与腹腔镜组相比阴道流血时间较短、住院时间较短,血β-HCG恢复正常时间较长,组间差异具有统计学意义(P<0.05)。两组月经恢复时间无明显差异(P>0.05)。两组术后并发症发生率无明显差异(P>0.05)。腹腔镜组与宫腔镜组相比随访1年的再次妊娠率较高、再次瘢痕妊娠率较低,组间差异具有统计学意义(P<0.05)。结论宫腔镜手术和腹腔镜手术治疗Ⅱ型瘢痕妊娠患者均具有良好的临床效果和安全性。宫腔镜手术治疗Ⅱ型瘢痕妊娠的优势在于手术时间较短、手术失血量较少、术后阴道流血时间较短、住院时间较短,无明显并发症。腹腔镜手术治疗Ⅱ型瘢痕妊娠患者血β-HCG恢复正常时间较宫腔镜手术短、随访1年的再次妊娠率较高、再次瘢痕妊娠率较低。

Objective To explore and analyze the clinical effect of hysteroscopic surgery and laparoscopic surgery in treating typeⅡscar pregnancy.Methods Totally 100 cases of women with typeⅡuterine scar pregnancy those admitted to our hospital from January 2016 to Jan 2019 were enrolled as study subjects,according to the different surgical methods they were divided into hysteroscopic surgery and laparoscopic surgery group,50 cases in each group.Perioperative indicators,postoperative recovery,the incidence of postoperative complications,rate of re-pregnancy and re-scarring pregnancy rate after 1 year follow-up of the two groups were compared.Results Compared with the laparoscopic group,the hysteroscopic group had shorter operation time and less blood loss,and the differences between the two groups were statistically significant(P<0.05).There was no significant difference in postoperative drainage volume(P>0.05).Compared with the laparoscopy group,the hysteroscopic group had shorter duration of vaginal bleeding,shorter length of hospital stay,bloodβ-HCG takes a long time to return to normal,and the differences were statistically significant(P<0.05).There was no significant difference in menstruation recovery time and incidence of complications between the two groups(P>0.05).Compared with the hysteroscopic group,the rate of re-pregnancy in the 1-year follow-up was higher in the laparoscopic group,and the rate of re-scarring pregnancy was lower,the differences between the groups were statistically significant(P<0.05).Conclusions Both hysteroscopic surgery and laparoscopic surgery have good clinical effect and safety in the treatment of patients with typeⅡscar pregnancy.The advantages of hysteroscopic surgery for the treatment of typeⅡscar pregnancy including the shorter operation time,the less blood loss,the shorter duration of vaginal bleeding,the length of hospital stay is shorter too,and there are no obvious complications.As for laparoscopic surgery the time bloodβ-HCG return to normal is shorter,the rate of re-pregnancy after 1 year follow-up is a little higher,and the rate of re-scarring pregnancy is lower than those in hysteroscopic surgery group.