摘要
目的研究Ⅰ、Ⅱ型剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)的临床特点及两种治疗方法的临床疗效。方法回顾性分析2018年3月至2020年7月收治的38例CSP患者的临床资料。所有患者术前用甲氨蝶呤(methotrexate,MTX)行预处理。根据手术方式分甲组(n=27)和乙组(n=11)。甲组采用超声监测下清宫组;乙组采用腹腔镜妊娠物清除术及子宫瘢痕修补术手术组。分析两组临床特征及患者围手术期情况,术后恢复及手术疗效。结果甲组手术时间术中出血量低乙组,差异均有统计学意义(P<0.05)。2组住院天数、术后正常月经来潮时间比较,差异无统计学意义(P>0.05),甲组术后β-HCG恢复正常时间高于乙组,术后肌层厚度低于乙组,差异均有统计学意义(P<0.05)。2组治疗总有效率比较,差异无统计学意义(P>0.05)。结论两种治疗方式均可用于Ⅰ、Ⅱ型CSP诊治,要根据患者具体情况采用个体化诊疗。Ⅰ型剖宫产瘢痕部位妊娠患者均采用超声监测下清宫术,安全有效、创伤小、花费低。腹腔镜CSP病灶切除术在保留患者生育功能的同时,具有成功率高、安全性高的优点,可作为Ⅱ型病例治疗的首选。
Objective To analyze the clinical characteristics and therapeutic efficacy of ultrasound-guided dilation and curettage(D&C)and laparoscopic excision of CSP with scar revision on type 1 and 2 cesarean scar pregnancy(CSP).Methods Clinical data of 38 CSP patients treated in our center from March 2018 to July 2020 were retrospectively analyzed.All recruited CSP patients were preoperatively treated with methotrexate.CSP patients were assigned to group A(n=27)and group B(n=11),in which they were surgically treated with ultrasound-guided D&C and laparoscopic excision of CSP with scar revision,respectively.Clinical characteristics,perioperative conditions,postoperative recovery and therapeutic efficacy between groups were compared.Results Significantly shorter surgery time and less intraoperative blood loss were recorded in group A than those of group B(both P<0.05).There were no significant differences in the length of stay and postoperative period between groups(both P>0.05).Compared with those of group B,significantly longer duration ofβ-subunit of hCG gonadotropin(β-hCG)recovery and higher postoperative muscular thickness were detected in CSP patients of group A(both P<0.05).The overall therapeutic efficacy between groups was comparable(P>0.05).Conclusion Both ultrasound-guided D&C and laparoscopic excision of CSP with scar revision can be applied to patients with type 1 and 2 CSP,which should be individually performed.Type 1 CSP should be surgically treated with ultrasound-guided D&C,which is highly effective and safe with less medical cost.Laparoscopic excision of CSP with scar revision is preferred to patients with type 2 CSP,which is featured by fertility preservation,high success rate and high safety.
作者
王泳
李萍
WANG Yong;LI Ping(The Third Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China)
出处
《河北医药》
CAS
2022年第10期1553-1555,共3页
Hebei Medical Journal
基金
河北省医学科学研究重点课题计划(编号:ZD20140048)。
关键词
子宫瘢痕妊娠
清宫术
子宫瘢痕修补术
cesarean scar pregnancy
dilation and curettage
uterine scar repair
