外生型剖宫产瘢痕妊娠三种治疗方法的对比研究  

Comparative Study of Three Treatments of Exogenous Cesarean Scar Pregnancy

作　　者：陈镘如[1] 梅立[1] 谢兰[1] 周飞[1] 

机构地区：[1]四川省人民医院,四川成都610072

出　　处：《实用妇产科杂志》2015年第4期278-281,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的:对比分析外生型剖宫产瘢痕妊娠(CSP)三种治疗方法的临床疗效。方法:回顾性分析2010年1月至2014年8月在四川省人民医院诊治的59例外生型CSP患者的临床资料。按不同的手术方法分为:经阴道子宫下段妊娠病灶切除术组(经阴道组)19例;子宫动脉栓塞术联合宫腹腔镜治疗组(栓塞组)22例,腹腔镜下妊娠病灶切除术组(腹腔镜组)18例。观察3组患者术中出血量、手术时间、术后疼痛、术后肛门排气时间、住院时间、住院费用、血β-HCG降至正常时间、术后月经恢复时间。结果:经阴道组和栓塞组手术均顺利完成,无中转开腹,腹腔镜组有2例中转开腹。腹腔镜组患者术中出血量多于经阴道组和栓塞组(P<0.05),而经阴道组与栓塞组比较,差异无统计学意义(P>0.05)。经阴道组手术时间和术后肛门排气时间短于栓塞组和腹腔镜组(P<0.05),而腹腔镜组与栓塞组间比较,差异无统计学意义(P>0.05)。栓塞组与经阴道组及腹腔镜组比较,术后Ⅲ级疼痛发生率高,住院时间、月经恢复时间长,住院费用高,差异均有统计学意义(P<0.05);而腹腔镜组与经阴道组比较,差异无统计学意义(P>0.05)。3组血β-HCG下降至正常时间比较,差异无统计学意义(P>0.05)。结论:三种方式均可用于治疗外生型CSP,经阴道子宫下段妊娠病灶切除术优于子宫动脉栓塞联合宫腹腔镜治疗和腹腔镜下妊娠病灶切除术。Objective：To compare and analyze the clinical curative effect of three methods for the treatment of exogenous cesarean scar pregnancy（CSP）. Methods：From January 2010 to August 2014, the clinical data of 59 cases With CSP undergoing treatment in Sichuan Provincial People＇s Hospital were studied retrospectively. 59 pa- tients were divided into three groups：18 cases treated by laparoscopy（laparoscopic group） ;19 cases treated by transvaginal debridement（transvaginal group）;22 cases treated by Uterine artery embolization combined with hysteroscopy and laparoscopy group（embolism group）. The bleeding and operation time and postoperative pain, exhaust time and hospitalization time,cost of hospitalization, blood IS-HCG decreased to normal time, postopera- tive recovery time of menstrual were observed in the three groups of. Results ：The operations in transvaginal group and embolism group were successfully completed,without conversion to open surgery. Two cases of conversion to lapa- rotomy in laparoscopic group. Patients in the laparoscopic group bleeding more than those in transvaginal group and embolism group（P〈0. 05）,there was on significant difference on bleeding between transvaginal group and embolism group（ P〉0. 05）. Operation time and postoperative anal exhaust time in transvaginal group were shorter than those in embolism group and laparoscopic group（ P 〈0. 05） ,and there was on significant difference on operation time and post- operative anal exhaust time between laparoscopic group and embolism group （ P 〉 0. 05）. Compared to transvaginal group and the laparoscopic group, postoperative pain （Ⅲ） high incidence, hospitalization time, menstrual recovery time Embolism group was longer,the hospital cost was higher, the differences were statistically significant （ P 〈 0. 05） ; there was on significant difference on those indexes between transvaginal group and the taparoscopic group（ P 〉0. 05）. There was no significant difference on of the time that bl

关 键 词：剖宫产瘢痕妊娠 经阴式手术 子宫动脉栓塞术 宫腔镜 腹腔镜 

分 类 号：R714.32[医药卫生—妇产科学]