目的:本研究对阴式子宫疤痕妊娠病灶清除术治疗剖宫产术后疤痕妊娠的疗效观察,为临床诊断提供参考.方法:选择我院2010年1月至2015年3月期间诊治的剖宫产术后疤痕妊娠患者151例进行分析.所有患者随机分为两组;常规治疗组(n=79)和阴式手术组(n=71).常规治疗组行B超引导下负压吸宫术,阴式手术组患者行经阴道子宫疤痕病灶清除术+疤痕修补术.分析两组患者术后β-HCG的转阴时间及子宫前壁下段剖宫产疤痕部位包块消失时间、术后6个月B超切口肌层厚度、术中出血量、手术时间、住院天数及治疗后阴道流血时间及月经恢复之间变化.结果:与常规治疗组相比,阴式手术组患者β-HCG转阴时间短(P＜0.01)、术后子宫前壁下段剖宫产疤痕部位包块消失快(P＜0.01),术后切口肌层厚度厚(P＜0.01),治愈率高、手术出血量少(P＜0.01),但手术时间长(P＜0.01);常规治疗组阴道流血时间及正常月经恢复时间明显长于阴式手术组,且术后需追加甲氨蝶呤的比例明显高于阴式手术组(P＜0.01).结论:阴式子宫疤痕妊娠病灶清除术治疗剖宫产术后疤痕妊娠的效果良好,值得临床推广.%Objectives:To explore the clinical effect and mechanism of trans-vaginal cesarean scar pregnancy debridement surgery treatment on cesarean scar pregnancy (CSP).Methods:151 CSP patients in our hospital from January 2010 to March 2015 were enrolled in this study and divided into 2 groups,conventional therapeutic group (n =79) and trans-vaginal operation group (n =71).The clearance time of β-HCG,front wall scar lasting time,blood loss volume during the operation and time of the operation were assayed in the two groups.The serum inflammatory factors were also be assayed in the two group after operation.80 healthy patients at the same period were taken as control.Results:The clearance time of β-HCG was shorter while the front wall scar disappeared faster in the trans-vaginal operation group (P ＜ 0.01).The blood loss volume during the operation was shorter while the time of the operation was longer in trans-vaginal operation group (P ＜ 0.01).The vaginal bleeding time and restore time of normal menstruation was longer in conventional therapeutic group,with higher ratio for methotrexate (P ＜0.01).Conclusion:Trans-vaginal operation shows effective effect on CSP patients which maybe relate with the regulation of serum inflammatory factors.
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