宫腔镜下清宫术联合药物治疗内生型剖宫产瘢痕妊娠的临床效果

Clinical Effect of Hysteroscopic Uterine Curettage Combined with Drugs in the Treatment of Endogenous Cesarean Scar Pregnancy

目的:分析宫腔镜下清宫术联合药物治疗内生型剖宫产瘢痕妊娠(CSP)的临床效果。方法:收集2021年1月—2023年1月上饶市立医院收治的124例内生型CSP患者为研究对象,采用随机数字表法分为对照组、观察组,各62例。对照组给予常规清宫术联合药物治疗,观察组给予宫腔镜下清宫术联合药物治疗。比较两组治疗效果,临床各项指标(包含手术时间、血β-hCG转阴时间、病灶B超检查消失时间、月经恢复时间、术中出血量及总住院时间),两组治疗前后炎症因子[白介素-2(IL-2)、C反应蛋白(CRP)]水平变化,并比较两组并发症发生率。结果:观察组治疗成功率为96.77%(60/62),明显高于对照组的85.48%(53/62)(P<0.05)。观察组手术时间及总住院时间均较对照组短,月经恢复时间较对照组早,术中出血量较对照组少,术后14 d血β-hCG转阴率、术后14 d病灶消失率均较对照组高,差异均有统计学意义(P<0.05)。治疗后两组IL-2、CRP均较治疗前明显增高,且观察组均明显低于对照组,差异均有统计学意义(P<0.05)。观察组并发症发生率较对照组明显低,差异有统计学意义(P<0.05)。结论:宫腔镜下清宫术联合药物治疗内生型CSP的成功率高,可明显缩短患者手术时间、血β-hCG转阴时间、病灶B超检查消失时间、月经恢复时间等,有效减轻手术创伤应激反应,减少并发症的发生。

Objective:To analyze the clinical effect of hysteroscopic uterine curettage combined with drugs in the treatment of endogenous cesarean scar pregnancy(CSP).Method:A total of 124 patients with endogenous CSP who were admitted to Shangrao Municipal Hospital from January 2021 to January 2023 were selected as the research subjects.According to the random number table,they were assigned to the control group and the observation group,62 cases per group.The control group was treated with conventional uterine curettage combined with drugs,while the observation group was treated with hysteroscopic uterine curettage combined with drugs.Therapeutic effects,clinical indicators(operation time,time forβ-hCG turning negative,disappearance time of lesion on B ultrasound,time of menstrual recovery,intraoperative blood loss and total length of hospital stay),changes of inflammatory factors[interleukin-2(IL-2)and C reactive protein(CRP)]before and after treatment,and the incidence of complications were compared between the groups.Result:The success rate of treatment in the observation group was 96.77%(60/62),which was significantly higher than 85.48%(53/62)in the control group(P<0.05).The operation time and total hospitalization time of the observation group were shorter than those of the control group,the menstrual recovery time were earlier than those of the control group,and the intraoperative blood loss was less than that of the control group,14 d postoperative,the negative conversion rate of bloodβ-hCG and the disappearance rate of lesions 14 days after surgery were higher than those in the control group,the differences were statistically significant(P<0.05).After treatment,the levels of IL-2 and CRP in the two groups increased,and the levels in observation group were significantly lower than those in the control group,the differences were significant(P<0.05).The incidence of complications in the observation group was significantly lower than that in the control group,the difference was statistically significant(P<0.05).Conclusion:Hysteroscopic uterine curettage combined with drug therapy can achieve a high success rate in the treatment of endogenous CSP,which can significantly shorten the operation time,the time of turning negative,the disappearance time of lesion on B ultrasound and the time of menstrual recovery,effectively relieve stress reaction and reduce complications.