摘要
目的 探讨不同术式联合治疗复杂剖宫产瘢痕妊娠（CSP）的临床疗效.方法 选取2010年6月至2015年6月解放军总医院收治的复杂CSP患者43例,依据不同的手术方式将患者分为腹腔镜＋清宫组（20例,在腹腔镜监测下行清宫术）、宫腔镜＋清宫组（10例,先行宫腔镜检查术,后行清宫术）、腹腔镜＋宫腔镜组（5例,在腹腔镜监视下宫腔镜清除病灶组织,之后在腹腔镜下修补子宫）、宫腔镜＋阴式手术组（8例,先行宫腔镜检查术,之后行经阴子宫瘢痕病灶切除术,并修补子宫）.比较4组患者病灶最大直径、妊娠囊距浆膜层最薄处厚度、手术持续时间、术中出血量、住院时间及人绒毛膜促性腺激素（HCG）恢复正常时间.结果 宫腔镜＋清宫组和宫腔镜＋阴式手术组各有1例出现术中大出血,经给予局部压迫,阻断双侧子宫动脉后继续手术.43例手术均成功,术后无需其他相关治疗.4组患者病灶最大直径差异无统计学意义（P＞0.05）.腹腔镜＋宫腔镜组妊娠囊距浆膜层最薄处厚度明显小于腹腔镜＋清宫组、宫腔镜＋清宫组和宫腔镜＋阴式手术组[（1.5±0.5）mm比（3.5±1.4）、（3.4±1.2）、（2.6 ±1.1）mm],宫腔镜＋清宫组手术持续时间明显长于腹腔镜＋清宫组、腹腔镜＋宫腔镜组和宫腔镜＋阴式手术组[（121±22） min比（74±35）、（98±14）、（80±18）min],腹腔镜＋清宫组和宫腔镜＋阴式手术组术中出血量大于宫腔镜＋清宫组和腹腔镜＋宫腔镜组[（67±32）、（70±41）ml比（55±29）、（50 ± 17） ml],宫腔镜＋清宫组和宫腔镜＋阴式手术组住院时间长于腹腔镜＋清宫组和腹腔镜＋宫腔镜组[（7.4±2.1）、（8.4±4.3）d比（4.9±3.7）、（4.2±1.0）d],腹腔镜＋宫腔镜组和宫腔镜＋阴式手术组HCG恢复正常时间短于腹腔镜＋清宫组和宫腔镜＋清宫组[（11±4）、（11±4）d比（14±3）、（14±4）d],差异均有�
Objective To discuss the clinical effect of different surgical treatments on complex cesarean scar pregnancy（SCP）.Methods Forty-three cases of complex CSP in PLA General Hospital from June 2010 to June 2015 were divided into four groups according to different surgical methods：curettage and aspiration ＋ laparoscopy （20 cases,curettage and aspiration guided by laparoscopy）,hysteroscopy ＋ curettage and aspiration （10 cases,hysteroscopy and then curettage and aspiration）,laparoscope ＋ hysteroscopy （5 cases,to remove the lesion tissue under hysteroscopy guided by laparoscopy,and then repair the uterus under the laparoscope） and hysteroscopy ＋ transvaginal surgery （8 cases,hysteroscopy,then remove the lesion tissue and then repair the uterus by transvaginal surgery）.The diameters of the gestational sac,minimal distance between conceptus and uterine serosa,surgery duration,intraoperative blood loss,hospitalstay and human chorionic gonadotropin （HCG） recovery time were compared among the four groups.Results There were 2 cases of intraoperative bleeding （hysteroscopy ＋ curettage and aspiration group and hysteroscopy ＋ transvaginal surgery group）.All of 43 patients were successfully operated.There was no significant difference among four groups regarding diameter of gestational sac （P 〉0.05）.The minimal distance of conceptus and uterine serosa of group laparoscope ＋ hysteroscopy was shorter than that of the group curettage and aspiration ＋ laparoscopy,group hysteroscopy ＋ curettage and aspiration and group hysteroscopy ＋ transvaginal surgery[（1.5 ± 0.5） mm vs （3.5 ± 1.4）,（3.4 ± 1.2）,（2.6 ± 1.1）mm] （P 〈 0.05）.The surgery duration in group hysteroscopy ＋ curettage and aspiration was significandy longer than that in group curettage and aspiration ＋ laparoscopy,group laparoscope ＋ hysteroscopy and group hysteroscopy ＋ transvaginal surgery[（121 ±22） min vs （74 ±35）,（98 ± 14）,（80 ± 18）min] （P 〈0.05）.There was more
出处
《中国医药》
2016年第5期724-728,共5页
China Medicine
关键词
剖宫产瘢痕妊娠
腹腔镜
宫腔镜
联合治疗
Cesarean scar pregnancy
Laparoscopes
Hysteroscopes
Combined therapy
