经阴道剖宫产瘢痕妊娠病灶切除术临床治疗效果分析

Clinical treatment effect of transvaginal debridement for cesarean scar pregnancy

目的探讨经阴道剖宫产疤痕妊娠病灶切除术治疗外生型剖宫产瘢痕妊娠的安全性及应用价值。方法回顾性分析了2012年1月至2016年5月在广东省佛山市妇幼保健院妇科收治的76例剖宫产瘢痕妊娠(CSP)患者的临床资料。76例患者分别按子宫瘢痕处肌层组织厚度、β-人绒毛膜促性腺激素(β-hCG)值、包块大小各分为两组,比较两组患者的手术时间、术中出血量、术后住院时间、β-hCG下降至正常时间。结果 76例患者根据疤痕厚度分为2～3mm组及<2mm组,两组患者的手术时间、术中出血量、住院时间、术后β-hCG值下降至正常时间比较均无统计学差异(t值分别为0.37、1.56、1.21、0.42,均P>0.05)。76例患者根据β-hCG水平分为≤50 000IU/L组和>50 000IU/L组,两组患者的手术时间、住院时间、术后β-hCG值下降至正常时间比较均无统计学差异(t值分别为0.98、0.04、0.22,均P>0.05);>50 000IU/L组术中出血量高于≤50 000IU/L组,差异有统计学意义(t=5.89,P<0.01)。76例患者根据病灶大小分为≤5cm组和>5cm组,两组患者的手术时间、术中出血量、住院时间、术后β-hCG值下降至正常时间比较均无统计学差异(t值分别为0.76、1.08、0.28、1.12,均P>0.05)。结论经阴道剖宫产瘢痕妊娠病灶切除术是一种安全有效的微创手术方式,值得推广。

Objective To explore the safety and application value of transvaginal debridement in the treatment of exogenous cesarean scar pregnancy.Methods A retrospective analysis was made on the clinical data of 76 patients with CSP who were admitted to the Department of Gynecology in Foshan Maternal and Child Health Care Hospital from January 2012 to May 2016.The cases were divided into two groups according to the thickness of muscular layer in uterus scar,β-hCG value and the size of the lump.The operation time,blood loss,postoperative hospital stay and time forβ-hCG decreasing to normal were compared between two groups.Results Seventy-six cases were divided into group with scar thickness of 2-3 mm and group with scar thickness less than 2 mm according to the thickness of the scar.The operation time,blood loss,hospital stay,and time forβ-hCG decreasing to normal were not significantly different between two groups(t value was 0.37,1.56,1.21 and 0.42,respectively,all P>0.05).All the patients were divided into group withβ-hCG>50000 IU/L and group withβ-hCG≤50000 IU/L according toβ-hCG level.There were no significant differences in operation time,hospital stay,time forβ-hCG decreasing to normal between two groups(t value was 0.98,0.04 and 0.22,respectively,all P>0.05).In group withβ-hCG>50000 IU/L,the intraoperative blood loss was higher than that in the group withβ-hCG≤50000 IU/L,and the difference was significant(t=5.89,P<0.01).All of the patients were divided into group with lesion size≤5 cm and group with lesion size>5 cm according to lesion size.The operation time,blood loss,hospital stay,time forβ-hCG decreasing to normal between two groups were not statistically different(t value was 0.76,1.08,0.28 and 1.12,respectively,all P>0.05).Conclusion Transvaginal debridement for cesarean scar pregnancy is a kind of minimally invasive surgery,which is an effective treatment and easy to be popularized.