腹腔镜下子宫瘢痕处妊娠物切除术联合宫腔镜下探查术治疗Ⅱ型或Ⅲ型剖宫产术后子宫瘢痕妊娠的临床效果

Clinical effect of laparoscopic pregnancy residues excision combined with hysteroscopic exploration in the treatment of type Ⅱ or type Ⅲ cesarean scar pregnancy

目的探讨腹腔镜下子宫瘢痕处妊娠物切除术联合宫腔镜下探查术治疗Ⅱ型或Ⅲ型剖宫产术后子宫瘢痕妊娠(CSP)的临床效果。方法抽取2018年1月至2020年12月中国人民解放军联勤保障部队第九八九医院Ⅱ型或Ⅲ型剖宫产术后CSP患者118例,按随机数字表法分为观察组(59例)与对照组(59例),对照组采用阴式手术局部切除子宫瘢痕处妊娠物,观察组采用腹腔镜下子宫瘢痕处妊娠物切除术联合宫腔镜下探查术,对比两组临床效果、围术期情况、术后恢复情况、并发症发生率和术前、术后1 d生理应激指标。结果观察组总有效率(91.53%)与对照组(84.75%)比较,差异未见统计学意义(P>0.05);观察组手术时间较对照组长,术中出血量、术后出血量较对照组少(P<0.05);观察组HCG恢复时间、月经恢复时间、住院时间短于对照组(P<0.05);术后1 d,两组COR、CRP水平均较术前增高,但观察组皮质醇(COR)、C反应蛋白(CRP)水平低于对照组(P<0.05);观察组并发症发生率(3.39%)与对照组(8.47%)比较,差异未见统计学意义(P>0.05)。结论腹腔镜下子宫瘢痕处妊娠物切除术联合宫腔镜下探查术治疗Ⅱ型或Ⅲ型剖宫产术后CSP患者效果确切,手术时间相对较长,但可减少围术期出血量,减轻生理应激,加快患者术后恢复进程,且具有安全性。

Objective To analyze the clinical effect of laparoscopic pregnancy residues excision combined with hysteroscopic exploration in the treatment of type Ⅱ or type Ⅲ cesarean scar pregnancy(CSP).Methods A total of 118 patients with CSP after type Ⅱ or type Ⅲ cesarean section in the 989th Hospital of the Joint Logistic Support Force of the People’s Liberation Army from January 2018 to December 2020 were selected,and divided into observation group(n=59)and control group(n=59)according to the random number table method.The control group was treated by vaginal surgery to locally remove the pregnancy residues,and the observation group was treated by laparoscopic pregnancy residues resection combined with hysteroscopic exploration.The clinical effect,perioperative condition,postoperative recovery,complication rate and physiological stress index before and after operation were compared between the two groups.Results The total effective rate of the observation group(91.53%)was compared with that of the control group(84.75%),the difference was not statistically significant(P>0.05).The operation time of the observation group was longer than that of the control group,the intraoperative blood loss and postoperative blood loss of the two groups were less than those of the control group,the difference was statistically significant(P<0.05).The recovery time,menstrual recovery time and hospitalization time of the observation group were shorter than those of the control group(P<0.05).One day after operation,the levels of COR and CRP in the two groups were higher than those before operation,but the levels of Cortisol(COR)and C-reactive protein(CRP)in the observation group were lower than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of complications between the observation group(3.39%)and the control group(8.47%),P>0.05.Conclusions Laparoscopic pregnancy residues excision combined with hysteroscopic exploration is effective in treating CSP patients after type Ⅱ or type Ⅲ cesarean section.The operation time is relatively long,but it can reduce the amount of bleeding during the perioperative period,reduce physiological stress,and accelerate the recovery process of patients after surgery,and it is safe.