摘要
目的比较不同手术方法治疗Ⅱ型剖宫产瘢痕妊娠(CSP)的临床效果,并探讨其应用指征。方法回顾性分析宁波市妇女儿童医院2020年1月至2021年12月收治的123例Ⅱ型CSP患者。根据患者治疗方案的不同分为A组(子宫动脉栓塞术+清宫术,48例)、B组(宫腔镜妊娠物清除术,45例)和C组(宫腹腔镜联合妊娠物清除术,30例)。收集患者的基线资料、术中情况和术后情况等。结果三组流产次数、年龄、剖宫产次数等基线资料及胚胎有无胎心、瘢痕厚度、术后第一天人绒毛膜促性腺激素(hCG)下降率等比较,差异无统计学意义(P>0.05)。C组停经时间、术前hCG、孕囊最大径线、手术时间、术中出血量、住院费用、hCG恢复正常时间均长于或高于A组和B组(P<0.05)。A组住院费用高于B组、手术时间长于B组(P<0.05);A组和B组hCG恢复时间比较,差异无统计学意义(P>0.05)。B组术中有3例出现了阴道大出血,行宫腔球囊填塞术;而A组和C组手术均成功,术中出血少。A组和C组住院时间差异无统计学意义(P>0.05),但均长于B组(P<0.05)。B组未出现术后并发症,A组有1/3、C组有1/10出现了发热等术后并发症。结论对于Ⅱ型CSP患者,单纯宫腔镜手术创伤小、费用最低,且手术时间及术后hCG恢复时间短,可作为首选治疗,但需严格告知患者风险,结合患者知情选择并准备完备的抢救措施;宫腹腔镜联合手术可作为备选方案,适用于孕周较大、出血风险高、有再生育要求的患者。
Objective To compare the clinical efficacy of different surgical methods for the treatment of cesarean scar pregnancy(CSP)and to explore their application indicators.Methods A retrospective analysis was conducted on 123 patients with typeⅡCSP admitted to Ningbo Women and Children′s Hospital between January 2020 and December 2021.Based on different treatment plans,patients were divided into group A(uterine artery embolization+dilation and curettage,48 cases),group B(hysteroscopic removal of the gestational product,45 cases),and group C(combined hysteroscopic and laparoscopic removal of the gestational product,30 cases).Baseline data,intraoperative conditions,and postoperative conditions of the patients were collected.Results There were no statistically significant differences in comparing baseline data such as number of abortions,age,number of cesarean sections,as well as in the presence or absence of fetal cardiac activity,scar thickness,and human chorionic gonadotropin(hCG)decrease rate on the first postoperative day among the three groups(P>0.05).In Group C,the duration of amenorrhea,preoperative hCG,maximum gestational sac diameter,operative time,intraoperative blood loss,hospitalization costs,and time to hCG normalization were all longer or higher than those in groups A and B(P<0.05).Group A had higher hospitalization costs and longer operative time than group B(P<0.05).There was no statistically significant difference in comparing hCG recovery time between groups A and B(P>0.05).In group B,3 cases experienced massive vaginal bleeding during surgery and required uterine balloon tamponade,while surgeries in groups A and C were successful with minimal intraoperative bleeding.There was no statistically significant difference in length of hospital stay between groups A and C(P>0.05),but both were longer than that in group B(P<0.05).No postoperative complications occurred in group B,whereas postoperative complications such as fever occurred in 1/3 of patients in group A and 1/10 in group C.Conclusions For patients with typeⅡCSP,hysteroscopic surgery alone is less invasive,has the lowest cost,and offers shorter operative time and faster postoperative hCG recovery,making it the preferred treatment.However,patients must be strictly informed of the risks,make informed choices,and ensure that comprehensive rescue measures are prepared.Combined hysteroscopic and laparoscopic surgery can be an alternative option,and it is suitable for patients with advanced gestational age,high risk of bleeding,or a desire for future fertility.
作者
何扬舟
范忆滢
张伟峰
HE Yangzhou;FAN Yiying;ZHANG Weifeng(Department of Obstetrics and Gynecology,Ningbo Women and Children′s Hospital,Ningbo 315000,Zhejiang,China)
出处
《中国性科学》
2025年第12期71-75,共5页
Chinese Journal of Human Sexuality
关键词
剖宫产瘢痕妊娠
子宫动脉栓塞术后清宫术
宫腔镜手术
腹腔镜与宫腔镜联合手术
Cesarean scar pregnancy
Uterine artery embolization followed by dilation and curettage
Hysteroscopic surgery
Combined hysteroscopic and laparoscopic surgery
