宫腹腔镜联合手术治疗内生型剖宫产瘢痕妊娠的临床效果

Clinical effect of hysteroscopy combined with laparoscopy surgery in the treatment of endogenous cesarean scar pregnancy

目的探讨宫腹腔镜联合手术治疗内生型剖宫产瘢痕妊娠(CSP)的临床效果。方法选取2019年2月至2021年1月我院收治的70例内生型CSP患者作为研究对象,根据手术方式不同将其分为乙组与甲组,各35例。乙组给予腹腔镜手术治疗,甲组在乙组基础上给予宫腔镜手术治疗。比较两组的手术相关情况、瘢痕形态、子宫内膜厚度、血清人绒毛膜促性腺激素(HCG)水平及性功能评分。结果两组的手术时间、住院时间、手术成功率、并发症总发生率比较,差异无统计学意义(P>0.05);甲组的术中失血量少于乙组,阴道流血时间、月经复潮时间短于乙组,差异具有统计学意义(P<0.05)。甲组的瘢痕长度、宽度及深度均小于乙组,子宫内膜厚度大于乙组,差异具有统计学意义(P<0.05)。治疗前,两组的血清HCG水平及性功能评分比较,差异无统计学意义(P>0.05);治疗后,甲组的血清HCG水平低于乙组,性功能评分高于乙组,差异具有统计学意义(P<0.05)。结论宫腹腔镜联合手术治疗内生型CSP的效果较好,可减少术中失血量,缩短阴道流血时间、月经复潮时间,加速瘢痕愈合,促进子宫内膜、血清HCG水平及性功能快速恢复,值得临床推广和应用。

Objective To investigate the clinical effect of hysteroscopy combined with laparoscopy surgery in the treatment of endogenous cesarean scar pregnancy(CSP).Methods A total of 70 patients with endogenous CSP treated in our hospital from February 2019 to January 2021 were selected as the research objects.The patients were divided into group B and group A according to the different surgical methods,with 35 cases in each group.The group B was treated with laparoscopy surgery,and the group A was treated with hysteroscopy surgery on the basis of the group B.The operation related condition,scar morphology,endometrial thickness,serum human chorionic gonadotropin(HCG)level and sexual function score were compared between the two groups.Results There were no significant differences in the operation time,hospital stay,operation success rate and total incidence of complications between the two groups(P>0.05);the intraoperative blood loss in the group A was less than that in the group B,the vaginal bleeding time and menstrual rehydration time were shorter than those in the group B,and the differences were statistically significant(P<0.05).The length,width and depth of scar in the group A were less than those in the group B,the endometrial thickness was greater than that in the group B,and the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in the serum HCG level and sexual function score between the two groups(P>0.05);after treatment,the serum HCG level in the group A was lower than that in the group B,the sexual function score was higher than that in the group B,and the differences were statistically significant(P<0.05).Conclusion Hysteroscopy combined with laparoscopy surgery in the treatment of endogenous CSP has a better effect.It can reduce the intraoperative blood loss,shorten the vaginal bleeding time and menstrual rehydration time,accelerate scar healing,and promote the rapid recovery of endometrium,serum HCG level and sexual function.It is worthy of clinical promotion and application.