摘要
目的探讨宫腔镜检查在剖宫产瘢痕妊娠(CSP)分型和治疗中的应用价值。方法选取70例病情稳定的CSP患者,均行宫腔镜检查,并根据宫腔镜所见妊娠物着床部位在子宫瘢痕上的面积将患者分为部分型CSP和完全型CSP。部分型CSP行宫腔镜指导下清宫术,完全型CSP行经阴道或经腹病灶切除术及子宫瘢痕修补术。记录患者术中出血量、术后阴道流血时间、术后3 d血清β-人绒毛膜促性腺激素(β-hCG)水平、术后月经恢复时间;比较部分型CSP和完全型CSP患者的停经天数、术前β-hCG值及胚囊直径。结果70例患者经宫腔镜检查分为完全型CSP 12例与部分型CSP 58例,术中出血量69(45,89)mL,术后阴道流血(8.4±1.5)d,术后(31.7±5.9)d月经恢复,术后3 d复查血清β-hCG水平均较术前下降60%以上,无持续性瘢痕妊娠、胚物残留发生,均临床治愈。部分型CSP与完全型CSP患者的停经天数、术前β-hCG值及胚囊直径比较,差异均无统计学意义(均P>0.05)。结论宫腔镜检查可在明确CSP分型的同时,结合B超所示孕囊距浆膜面厚度对CSP患者进行个性化治疗,安全、有效、创伤少。
Objective To explore the application value of hysteroscopy in the classification and treatment of cesarean scaRpregnancy(CSP).Methods Seventy patients with stable CSP were selected and underwent hysteroscopy.In addition,according to the area of pregnancy implantation on uterine scaRdisplayed by hysteroscope,the patients were divided into partial CSP and complete CSP.Partial CSP cases underwent hysteroscopy-guided curettage,and complete CSP cases underwent transvaginal oRtransabdominal lesion resection and uterine scaRrepair.The amount of bleeding during operation,duration of postoperative vaginal bleeding,serumβ-human chorionic gonadotropin(hCG)level three days afteRoperation,time to normal menstruation afteR operation were recorded in the patients.Menopause days,preoperativeβ-hCG value,and embryo sac diameteRwere compared between patients with partial CSP and complete CSP.Results Among the 70 patients,there were 12 cases of complete CSP and 58 cases of partial CSP identified by hysteroscopy,the intraoperative blood loss was 69(45,89)mL,the postoperative vaginal bleeding lasted foR8.4±1.5 days,the duration to normal menstruation postoperatively was 31.7±5.9 days,and serumβ-hCG level decreased by more than 60%in the reexamination three days afteRoperation compared to the preoperative level.No persistent scaRpregnancy oRtrophoblastic residual occurred,and all cases achieved clinically cured.There was no statistically significant difference in menopause days,preoperativeβ-hCG value,oRembryo sac diameteRbetween patients with partial CSP and complete CSP(all P>0.05).Conclusion Hysteroscopy can identify the classification of CSP,simultaneously,can be used to perform an individualized treatment of CSP patients in combination with the thickness of gestational sac from serosa surface shown by B-ultrasound,achieving safety,effectiveness and minoRtrauma.
作者
黄建邕
莫坚
韦素连
罗伟
HUANG Jian-yong;MO Jian;WEI Su-lian;LUO Wei(Department of Gynecology,the Fifth Affiliated Hospital of Guangxi Medical University,Nanning 530022,China)
出处
《广西医学》
CAS
2021年第9期1062-1064,共3页
Guangxi Medical Journal
基金
广西南宁市科学研究与技术开发计划(20173017-3)。
关键词
剖宫产瘢痕妊娠
宫腔镜检查
分型
个性化治疗
效果
Cesarean scaRpregnancy
Hysteroscopy
Classification
Individualized treatment
Effect
