宫腔镜诊治Ⅰ型剖宫产瘢痕妊娠的价值  

Clinical Value of Hysteroscopic Surgery for Type Ⅰ Cesarean Scar Pregnancy

作　　者：陈滢[1] 王晶[1] 杨赛花[1] 童明[1] 

机构地区：[1]广州军区武汉总医院妇产科,武汉430070

出　　处：《中国微创外科杂志》2016年第1期21-23,27,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨宫腔镜在Ⅰ型剖宫产瘢痕妊娠（cesarean scar pregnancy,CSP）诊治中的价值。方法回顾性分析我院2010年12月~2014年8月阴道彩色超声提示Ⅰ型CSP 173例,其中A组83例行双侧子宫动脉栓塞术,术后24 h行宫腔镜检查联合清宫术;B组90例行宫腔镜检查,并在宫腔镜直视下切除妊娠组织并电凝止血。比较2组术中、术后情况。结果宫腔镜检查证实为Ⅰ型CSP 148例,阴道彩色超声阳性符合率为85.5%（148/173）,假阳性率14.5%（25/173）。A组术中出血量（30.0±14.9）ml,显著多于B组（17.2±9.1）ml（t=6.362,P=0.000）;A组住院费用（12 046.4±984.8）元,显著多于B组（6511.3±826.5）元（t=37.137,P=0.000）;A组住院时间（5.6±0.9）d,显著长于B组（5.0±0.9）d（t=4.052,P=0.000）;A组盆腔疼痛和子宫穿孔的发生率显著高于B组（χ2=6.860,P=0.009;Fisher检验,P=0.024）。2组血β-h CG降至正常时间无统计学差异[（21.8±4.8）d vs.（20.9±4.9）d,t=1.127,P=0.261]。结论与双侧子宫动脉栓塞术联合清宫术相比,宫腔镜直视下切除妊娠组织处理Ⅰ型CSP术中出血量少,住院费用低,是治疗Ⅰ型CSP较理想的方法。Objective To explore the clinical application value of hysteroscopic surgery for type Ⅰ cesarean scar pregnancy（ CSP）. Methods A retrospective analysis was made on data of 173 cases of CSP diagnosed with transvaginal color Doppler ultrasound from December 2010 to August 2014 in this hospital,including 83 cases treated with bilateral uterine artery embolization and hysteroscopic negative pressure suction 24 hours later（ Group A） and 90 cases treated with hysteroscopic exploration and pregnancy tissue resection with local electric coagulation（ Group B）. Perioperative situations were assessed between the two groups. Results Among the 173 cases,type Ⅰ CSP was confirmed by hysteroscopy in 148 cases,showing a positive coincidence rate of 85. 5%（ 148 /173） and a false positive rate of 14. 5%（ 25 /173）. The intraoperative blood loss in the Group B（ 17. 2 ± 9. 1） ml was significantly lower than that in the Group A（ 30. 0 ± 14. 9） ml（ t = 6. 362,P = 0. 000）. The hospitalization costs in the Group B（ 6511. 3 ± 826. 5） yuan was significantly lower than that in the Group A（ 12 046. 4 ± 984. 8） yuan（ t = 37. 137,P = 0. 000）. The average length of hospital stay in the Group B（ 5. 0 ± 0. 9 d） was significantly shorter than in the Group A（ 5. 6 ± 0. 9 d）（ t = 4. 052,P = 0. 000）. The incidence of complications such as pelvic pain and uterine perforation was significant higher in the Group A than that in the Group B（ χ2= 6. 860,P = 0. 009; Fisher＇s test,P = 0. 024）. No significant difference was found between the two groups in recovery time of β-h CG [（ 21. 8 ± 4. 8） d vs.（ 20. 9 ± 4. 9） d,t = 1. 127,P = 0. 261]. Conclusions As compared with bilateral uterine artery embolization and hysteroscopic negative pressure suction,hysteroscopic pregnancy tissue resection for type Ⅰ CSP is more accurate,effective,minimally invasive,and inexpensive. It is an ideal option for the treatment of type Ⅰ CSP.

关 键 词：剖宫产瘢痕妊娠 宫腔镜 经阴道彩色超声 

分 类 号：R713.8[医药卫生—妇产科学]