宫腹腔镜联合手术治疗Ⅲ型瘢痕妊娠的疗效评价  

Combined laparoscopic and hysteroscopic surgery in treatment of typeⅢcesarean scar pregnancy

作　　者：高艳华[1] 魏杏茹 李全香[1] 杨平芳 严凤[1] GAO Yanhua;WEI Xingru;LI Quanxiang;YANG Pingfang;YAN Feng(Department of Obstetrics and Gynecology, Baoding Maternal and Child Health Care Hospital, Baoding 071000, Hebei Province, China)

机构地区：[1]河北省保定市妇幼保健院妇产科,河北保定071000

出　　处：《解放军医学院学报》2018年第12期1052-1054,1071,共4页Academic Journal of Chinese PLA Medical School

基　　金：河北省保定市科学技术和知识产权局(17ZF055)~~

摘　　要：目的总结Ⅲ型剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)病例资料,探讨宫腹腔镜联合手术疗法的临床价值。方法将保定市妇幼保健院妇产科2013年6月-2018年6月诊治的66例Ⅲ型CSP患者作为研究对象,依据手术方式分为三组:甲组(n=31)采用宫腹腔镜联合CSP胚物切除修补术,乙组(n=23)采用腹腔镜下CSP胚物切除修补术,丙组(n=12)采用阴式CSP胚物切除修补术。比较手术和疗效相关指标。结果甲组行子宫动脉栓塞或子宫动脉阻断术比例少于乙组和丙组[14例(45.2%) vs17例(73.9%)&10例(83.3%),P=0.024],甲组无中转其他手术,乙、丙组分别有2例中转其他手术者,术中出血量和手术时间指标三组比较差异无统计学意义(P> 0.05);丙组治疗费用少于甲组和乙组[(13 820.5±2281.3)元vs(19 602.9±3 630.7)元和(21 471.1±4 421.8)元,P <0.001],平均住院时间和疗效指标三组比较及两两组比较差异无统计学意义(P> 0.05)。结论宫腹腔镜联合手术治疗Ⅲ型CSP能够减少子宫动脉阻断的预处理,便于评估病情、降低手术风险,并能保证疗效。Objective To review the clinical data about patients with type Ⅲ cesarean scar pregnancy(CSP)and explore the clinical value of laparoscopic and hysteroscopic gynecological surgery.Methods Totally 66 patients with type Ⅲ CSP who were treated in our hospital from June 2013 to June 2018 were selected as research subjects.According to the operation methods,they were divided into three groups,combined laparoscopic and hysteroscopic gynecological surgery group(group A,n=31),laparoscopic surgery alone group(group B,n=23)and transvaginal surgery group(group C,n=12).The operative and therapeutic indicators were analyzed and compared.Results The number of patients in group A underwent uterine artery embolization or uterine artery occlusion was less than that in group B and group C [14 cases(45.2%)vs 17 cases(73.9%)and 10 cases(83.3%),P=0.024].No patient transferred to other operation in group A,but 2 cases in group B and 2 cases in group C had transferred to other operation.The treatment costs of group C was significantly less than that of group A and group B [(13 820.5±2 281.3)yuan vs(19 602.9±3 630.7)yuan and(21 471.1±4 421.8)yuan,P<0.001].There was no significant difference in other indicators.Conclusion Combined laparoscopic and hysteroscopic surgery for treatment of type Ⅲ CSP can reduce the rate of uterine artery embolization /occlusion,facilitate the evaluation of the disease,reduce the risk of surgery and ensure the efficacy.

关 键 词：瘢痕妊娠 宫腔镜手术 腹腔镜手术 阴式手术 

分 类 号：R714.22[医药卫生—妇产科学]