经阴道子宫下段病灶切除术在外生型剖宫产切口部妊娠患者中的应用效果  

Application Effect of Transvaginal Resection of Lower Uterine Lesions in Patients with Exogenous Cesarean Scar Pregnancy

作　　者：岳永华 张改玲 安清敏 YUE Yonghua;ZHANG Gailing;AN Qingmin(Department of Obstetrics and Gynecology,Linying County Maternal and Child Health Hospital,Luohe 462600,China)

机构地区：[1]临颍县妇幼保健院妇产科,河南漯河462600

出　　处：《河南医学研究》2022年第14期2583-2586,共4页Henan Medical Research

摘　　要：目的分析经阴道子宫下段病灶切除术在外生型剖宫产切口部妊娠(CSP)患者中的应用价值。方法选取2017年2月至2020年7月临颍县妇幼保健院收治的93例外生型CSP患者,根据手术方式分为腹腔镜组(46例)和经阴道组(47例)。腹腔镜组患者接受腹腔镜下病灶切除术治疗,经阴道组患者接受经阴道子宫下段病灶切除术治疗。比较两组手术相关指标[主要包括手术时间、术中出血量、排气时间、β-人绒毛膜促性腺激素(β-HCG)恢复正常时间、月经复潮时间]、并发症发生率、术前及术后12 h创伤应激指标[主要包括血清去甲肾上腺素(NE)、皮质醇(Cor)]水平以及术后1、3、5 d视觉模拟评分法(VAS)评分。结果经阴道组患者的手术、排气时间均短于腹腔镜组,术中出血量少于腹腔镜组(P<0.05);术后1、3、5 d,经阴道组患者的VAS评分均低于腹腔镜组(P<0.05);经阴道组并发症发生率(4.26%)低于腹腔镜组(19.57%)(P<0.05);术后12 h,经阴道组患者的血清NE、Cor水平低于腹腔镜组(P<0.05)。结论经阴道子宫下段病灶切除术治疗外生型CSP患者,可有效减轻患者的创伤应激及术后疼痛,优化手术相关指标,还可降低并发症的风险,安全可靠。Objective To analyze the application value of transvaginal resection of lower uterine lesions in patients with exogenous cesarean scar pregnancy(CSP).Methods A total of 93 patients with exogenous CSP in Linying County Maternal and Child Health Hospital from February 2017 to July 2020 were selected and divided into laparoscopic group(46 cases)and transvaginal group(47 cases)according to surgical methods.Patients in the laparoscopic group were treated with laparoscopic lesion resection,and patients in the transvaginal group were treated with transvaginal resection of lower uterine lesions.The operation-related indicators[mainly including operating time,intraoperative blood loss,exhaust time,β-human chorionic gonadotropin(β-HCG)returning to normal time,menstrual regain time],complication rate,traumatic stress[serum norepinephrine(NE),cortisol(Cor)]levels before and after 12 hours of operation and visual analogue scale(VAS)scores after 1,3,and 5 days of operation were compared between laparoscopic group and transvaginal group.Results The operation and exhaust time of the transvaginal group were shorter than those of the laparoscopic group,and the amount of intraoperative blood loss was less than that of the laparoscopic group(P<0.05).The VAS scores of the transvaginal group were lower than those of the laparoscopic group after 1,3,and 5 days of operation(P<0.05).The complication rate of the transvaginal group(4.26%)was lower than that(19.57%)of the laparoscopic group(P<0.05).The serum levels of NE and Cor of the transvaginal group were lower than those of the laparoscopic group after 12 hours of operation(P<0.05).Conclusion Transvaginal resection of the lower segment of the uterus in the treatment of exogenous CSP patients can significantly reduce traumatic stress and postoperative pain,optimize surgical indicators,and reduce the risk of complications,and is safe and reliable.

关 键 词：外生型剖宫产切口部妊娠 经阴道子宫下段病灶切除术 并发症 术后疼痛 创伤应激 

分 类 号：R714.21[医药卫生—妇产科学]