宫腹腔镜联合手术治疗Ⅱ型瘢痕妊娠的临床疗效

Clinical efficacy of hysteroscopy combined with laparoscopy in the treatment of typeⅡcesarean scar pregnancy

目的探讨宫腹腔镜联合手术治疗Ⅱ型瘢痕妊娠(CSP)的临床疗效。方法选取2018年6月至2021年1月于本院治疗的78例Ⅱ型CSP患者作为研究对象,按照随机数字表法分为观察组与对照组,各39例。对照组采取传统开腹手术治疗,观察组采取宫腹腔镜联合手术治疗。比较两组术后不同时间点β-人绒毛膜促性激素(β-hCG)下降率、手术情况及术后恢复状况。结果两组β-hCG下降率组间、时间、交互比较差异有统计学意义(P<0.05)。组内比较:两组术后各时间点β-hCG下降率明显高于前一时间点,差异有统计学意义(P<0.05)。组间比较:术后48 h、1周、2周、4周,观察组β-hCG下降率均高于对照组,差异有统计学意义(P<0.05)。观察组手术时间、住院时间均短于对照组,术中出血量明显少于对照组,差异有统计学意义(P<0.05)。观察组月经复潮时间、子宫恢复时间及阴道流血时间均短于对照组,差异有统计学意义(P<0.05)。结论宫腹腔镜联合手术治疗Ⅱ型CSP的临床疗效显著,可降低患者β-hCG水平,缩短手术时间、住院时间,促进患者机体恢复,降低复发风险,值得临床推广应用。

Objective To investigate the clinical efficacy of hysteroscopy combined with laparoscopy in the treatment of typeⅡcesarean scar pregnancy(CSP).Methods 78 patients with typeⅡCSP treated in the hospital from June 2018 to January 2021 were selected as the research subjects,and they were divided into the observation group and the control group according to random number table method,with 39 cases in each group.The control group underwent traditional laparotomy,while the observation group underwent hysteroscopy combined with laparoscopy.The decrease rates of human chorionic gonadotrophin-β(β-hCG)at different time after surgery,surgical conditions and postoperative recovery were compared between the two groups.Results There were statistically significant differences of the decrease rate ofβ-hCG between two groups of group,time points and interaction(P<0.05).Comparison within the group:the decline rate ofβ-hCG at each time point after the two groups was significantly higher than that at the previous time point,and the difference was statistically significant(P<0.05).Comparison between groups:48 h,1 week,2 weeks,and 4 weeks after operation,the decrease rate ofβ-hCG in the observation group was higher than that in the control group,and the difference was statistically significant(P<0.05).The operation time and hospital stay in the observation group were shorter than those in the control group,and the blood loss during operation was significantly less than that in the control group,and the differences were statistically significant(P<0.05).The menstrual reflux time,uterine recovery time and vaginal bleeding time in the observation group were all shorter than those in the control group,and the differences were statistically significant(P<0.05).Conclusion The clinical efficacy of hysteroscopy combined with laparoscopy in the treatment of typeⅡCSP is significant,which can reduce the level ofβ-hCG of patients,shorten the operation time and hospitalization time,promote the recovery of patients,and reduce the risk of recurrence,which is worthy of clinical promotion and application.