子宫切口瘢痕妊娠经阴道与腹腔镜手术治疗的临床疗效比较  

To evaluate the clinical curative effect of surgery treatment of cesarean scar pregnancy bylparoscopic and transvaginal

作　　者：徐萍萍 曹莉莉[2] 阎萍[2] 梁志清[2] 徐惠成[2] 

机构地区：[1]解放军81医院妇产科,江苏南京210002 [2]第三军医大学西南医院妇产科,重庆400038

出　　处：《东南国防医药》2016年第6期594-596,共3页Military Medical Journal of Southeast China

摘　　要：目的探讨不同途径微创手术方式对剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的治疗价值。方法回顾性分析西南医院2013年2月-2015年5月32例外生型的剖宫产瘢痕妊娠(2级或3级)手术资料,其中20例行腹腔镜下瘢痕妊娠病灶清除术+切口修补术,12例行经阴道剖宫产瘢痕妊娠病灶清除术+切口修补术。结果腹腔镜手术组手术时间(96.9±19.5)min,出血量(109.4±46.5)m L;经阴道手术组手术时间(36.3±8.2)min,出血量(57.9±16.3)m L.。两组间相比较,经阴道手术组手术时间明显缩短,出血量也较腹腔镜手术组明显减少,差异具有统计学意义(P<0.01)。两组平均住院时间、术后血人绒毛膜促性腺激素(HCG)下降至正常时间相比较,差异无统计学意义(P>0.05)。结论对于超声检查明确诊断为外生型切口瘢痕妊娠的患者,无论选择哪种手术方式,均宜尽早实施,其中有良好阴道手术基础的医师,应尽量选择经阴道手术,能减少术中出血和缩短手术时间,并可很好修复缺陷瘢痕,是治疗外生型CSP的首选方法。Objective To explore the value of treatment on cesarean section scar pregnancy （cesarean scar pregnancy, CSP） with different of minimally invasive surgery methods. Methods The retrospective analysis was carried out on data of 32 cases of southwest hospital which were operated because of cesarean scar pregnancy （ level 2 to level 3） from February 2013 to May 2015. 20 patients underwent laparoscopic removal of lesions and incision scar pregnancy repair, and 12 patients underwent transvaginal surgery. Results The average surgery time were （96.9±19.5） min of laparoscopic group and （36.3±8.2） min of transvaginal surgical. The blood loss were （109.4 ±46.5） mL in laparoscopic group and （57.9±16.3） mL in transvaginal surgical group. The operation time of transvaginal group was obviously shortened and the bleeding also significantly decreased than laparoscopic group （ P〈0.05） . The average hospital stay and the postoperative recovery time of HCG were not statistically significant between two groups （ P〉0.05） . Conclusion The exogenous cesarean scar pregnancy diagnosed by ultrasound, laparoscopic surgery and transvaginal operations should be implemented as soon as possible. Transvaginal surgical should be chosen as the first method for the doctor who has good transvaginal surgical experiment. Transvaginal surgical is the preferred method for the treatment of exogenous type CSP because it can reduce intraoperative blood lose and shorten the operation time and is benefical for repair defects of scar.

关 键 词：瘢痕妊娠 腹腔镜 阴式手术 

分 类 号：R713.8[医药卫生—妇产科学]