多次宫腔镜手术及宫腹腔镜联合手术对于Ⅲ型剖宫产瘢痕妊娠的治疗效果分析

摘要

Objective:To explore the clinical treatment effect of repeated hysteroscopy and hysteroscopy combined with laparoscopy on Type Ⅲ cesarean scar pregnancy(CSP).Methods:Forty one patients diagnosed as Type Ⅲ CSP in Shengjing Hospital affiliated to China Medical University from December 2012 to June 2016 were included in the study.The patients were divided into two groups:the patients were treated by repeated hysteroscopic CSP resection in Group A(n=20),and the patients were treated by hysteroscopic combined with laparoscopic CSP resection and uterine repair in Group B(n=21).The operation status,operation success rate,postoperative recovery and repregnancy were compared between the two groups.Results:The accumulated operation time in Group B was significantly longer than that in Group A [(71.2±9.5)vs.(59.2±6.9)min](P＜0.05).The time of menstruation recovery in Group B was significantly shorter than that in Group A [(32.1±4.6)vs.(39.3±6.8)days](P＜0.05),and the time of HCG descending to normal level in Group B was significantly shorter than that in Group A [(27.3±5.1) vs.(34.7 ± 5.6)days] (P＜0.05).There was no significant differences in bleeding volume,operation complication and success rate between the two groups(P＞0.05).Seven patients were re-pregnancy during followed-up in the two groups,and no recurrence of CSP occurred.Conclusions:Both repeated hysteroscopy and hysteroscopy combined with laparoscopy can be used for treatment of Type Ⅲ cesarean scar pregnancy.In clinical practice,appropriate surgical options can be selected according to the patient's condition.%目的 比较多次宫腔镜及宫腹腔镜联合手术应用于Ⅲ型剖宫产瘢痕妊娠(CSP)患者的治疗效果. 方法 回顾性分析我院2012年12月至2016年6月确诊CSP患者的临床资料,选择其中Ⅲ型患者共41例,根据手术方式的不同分为两组:A组(20例)先后行两次宫腔镜CSP病灶切除术;B组(21例)行宫腔镜探查术+腹腔镜CSP病灶切除术+子宫修补术.比较两组患者手术情况、手术成功率、术后恢复情况及再次妊娠结局. 结果 与A组相比,B组累积手术时间显著延长[(71.2±9.5)min vs.(59.2±6.9)min](P＜0.05),月经恢复时间[(32.1±4.6)d vs.(39.3±6.8)d]及术后血HCG下降至正常范围时间[(27.3±5.1)d vs.(34.7±5.6)d]显著缩短(P均＜0.05).两组患者的术中出血量、并发症发生情况、手术成功率等比较均无显著性差异(P＞0.05).两组共随访到7例患者再次妊娠,均无再次CSP发生. 结论 多次宫腔镜手术及宫腹腔镜联合手术对于Ⅲ型CSP患者均有很好的治疗效果,在临床中可以根据患者具体情况选择合适的手术方案.