剖宫产瘢痕妊娠经不同手术方式处理的临床效果分析  

Analysis of clinical effect of caesarean scar pregnancy treated by different surgical methods

作　　者：胡美霞[1] 张莹[1] 胡泊[1] HU Meixia;ZHANG Ying;HU Bo(Department of Gynaecology,Maternal and Child Health Hospital of Jiujiang City in Jiangxi Province,Jiujiang 332000,China)

机构地区：[1]江西省九江市妇幼保健院妇科,江西九江332000

出　　处：《中国现代医生》2020年第33期92-95,99,共5页China Modern Doctor

摘　　要：目的分析剖宫产瘢痕妊娠(CSP)经不同手术方式处理的临床效果,探讨CSP适宜的治疗方法。方法回顾性分析2014年1月~2019年12月在九江市妇幼保健院手术治疗的362例CSP患者的临床资料,按不同手术方式分为三组:B超引导下刮宫术121例(A组)、腹腔镜下或经阴道CSP清除术+子宫下段缺陷修补术78例(B组)和宫腔镜下CSP清除术163例(C组)。比较分析各组CSP的术中出血量、术中并发症、手术成功率和术后胚物残留情况。结果三组手术成功率和术后胚物残留组间两两比较,差异无统计学意义(P>0.05),术中出血量B组[(142.8±9.6)mL]>A组[(73.4±3.6)mL]>C组[(63.6±7.5)mL],组间两两比较,差异有统计学意义(P<0.01),B组术中并发症的发生(0/78)与A组(10/121)比较,差异有统计学意义(P<0.05)。Ⅱ型CSP术中出血量A组[(98.6±5.6)mL]>B组[(89.5±6.2)mL]>C组[(73.6±5.7)mL],组间两两比较,差异有统计学意义(P<0.05)。Ⅲ型术中出血量、术中并发症和手术成功率三项指标B组分别与A组和C组比较,差异有统计学意义(P<0.05)。结论三种手术方式治疗CSP具有安全、有效和微创的特点,但对不同类型CSP安全和疗效存在较大差异,因此治疗前应准确评估患者病情和CSP分型,采用适宜手术方式,达到减少出血和提高治愈率的目的。Objective To analyze the clinical effect of cesarean scar pregnancy(CSP)treated by different surgical methods,and to explore the appropriate treatment method for CSP.Methods The clinical data of 362 CSP patients treated by surgery in our hospital from January 2014 to December 2019 were retrospectively analyzed,and the patients were divided into group A(n=121),group B(n=78)and group C(n=163)according to different surgical methods.Group A was treated with B-ultrasound guided dilatation and curettage,group B was treated with laparoscopic or transvaginal removal of CSP+repair of defects in the lower uterine segment and group C was treated with hysteroscopic removal of CSP.Intraoperative blood loss,intraoperative complications,success rate of operation and postoperative embryo residue of CSP in each group were compared and analyzed.Results There was no statistically significant difference between the three groups in the success rate of operation and the postoperative embryo residue(P>0.05).Intraoperative blood loss in group B([142.8±9.6]mL)>group A([73.4±3.6]mL)>group C([63.6±7.5]mL),the difference between the three groups was statistically significant(P<0.01).Intraoperative complication rate in group B(0/78)was compared with that in group A(10/121),the difference was statistically significant(P<0.05).Intraoperative blood loss in the treatment of typeⅡCSP in group A([98.6±5.6]mL)>group B([89.5±6.2]mL)>group C([73.6±5.7]mL),the difference between the three groups was statistically significant(P<0.05).The three indicators of intraoperative blood loss in the treatment of typeⅢCSP,intraoperative complication rate and success rate of operation in group B were compared with those in group A and group C,respectively,and the differences were statistically significant(P<0.05).Conclusion The three surgical methods are safe,effective and minimally invasive in the treatment of CSP,but there are great differences in the safety and efficacy between different types of CSP.Therefore,patients'condition and CSP type should be

关 键 词：剖宫产瘢痕妊娠 腹腔镜 宫腔镜 刮宫术 

分 类 号：R713.8[医药卫生—妇产科学]