本文選題：剖宮產(chǎn)瘢痕妊娠　切入點(diǎn)：經(jīng)陰式手術(shù)　出處：《實(shí)用婦產(chǎn)科雜志》2015年04期

【摘要】：目的:對(duì)比分析外生型剖宮產(chǎn)瘢痕妊娠(CSP)三種治療方法的臨床療效。方法:回顧性分析2010年1月至2014年8月在四川省人民醫(yī)院診治的59例外生型CSP患者的臨床資料。按不同的手術(shù)方法分為:經(jīng)陰道子宮下段妊娠病灶切除術(shù)組(經(jīng)陰道組)19例;子宮動(dòng)脈栓塞術(shù)聯(lián)合宮腹腔鏡治療組(栓塞組)22例,腹腔鏡下妊娠病灶切除術(shù)組(腹腔鏡組)18例。觀察3組患者術(shù)中出血量、手術(shù)時(shí)間、術(shù)后疼痛、術(shù)后肛門排氣時(shí)間、住院時(shí)間、住院費(fèi)用、血β-HCG降至正常時(shí)間、術(shù)后月經(jīng)恢復(fù)時(shí)間。結(jié)果:經(jīng)陰道組和栓塞組手術(shù)均順利完成,無(wú)中轉(zhuǎn)開(kāi)腹,腹腔鏡組有2例中轉(zhuǎn)開(kāi)腹。腹腔鏡組患者術(shù)中出血量多于經(jīng)陰道組和栓塞組(P0.05),而經(jīng)陰道組與栓塞組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。經(jīng)陰道組手術(shù)時(shí)間和術(shù)后肛門排氣時(shí)間短于栓塞組和腹腔鏡組(P0.05),而腹腔鏡組與栓塞組間比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。栓塞組與經(jīng)陰道組及腹腔鏡組比較,術(shù)后Ⅲ級(jí)疼痛發(fā)生率高,住院時(shí)間、月經(jīng)恢復(fù)時(shí)間長(zhǎng),住院費(fèi)用高,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);而腹腔鏡組與經(jīng)陰道組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3組血β-HCG下降至正常時(shí)間比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:三種方式均可用于治療外生型CSP,經(jīng)陰道子宮下段妊娠病灶切除術(shù)優(yōu)于子宮動(dòng)脈栓塞聯(lián)合宮腹腔鏡治療和腹腔鏡下妊娠病灶切除術(shù)。
[Abstract]:Objective: to compare and analyze the clinical efficacy of three methods for treatment of ectogenic cesarean scar pregnancy. Methods: the clinical data of 59 patients with CSP in Sichuan Provincial people's Hospital from January 2010 to August 2014 were retrospectively analyzed. Materials. According to different surgical methods, they were divided into two groups: transvaginal hysterectomy group (19 cases); Uterine artery embolization combined with uterine laparoscopy (22 cases in embolization group and 18 cases in laparoscopy group). Time of hospitalization, cost of hospitalization, blood 尾 -HCG decreased to normal time, menstrual recovery time after operation. Results: the transvaginal group and embolization group were successfully completed, no conversion to laparotomy, In the laparoscopic group, the amount of intraoperative bleeding was higher than that in the transvaginal group and the embolization group (P 0.05), but the transvaginal group was compared with the embolization group. There was no significant difference between the two groups (P 0.05). The operation time and the postoperative anal exhaust time in the transvaginal group were shorter than those in the embolization group and the laparoscopic group, but there was no significant difference between the laparoscopy group and the embolization group. There was no significant difference between the embolization group and the transvaginal group and the laparoscopic group, and there was no significant difference between the transvaginal group and the laparoscopic group. The incidence of postoperative pain was higher, hospitalization time was longer, menstrual recovery time was longer, hospitalization cost was higher, and the difference was statistically significant (P 0.05), but there was no significant difference between laparoscopy group and transvaginal group in the decrease of serum 尾 -HCG to normal time. Conclusion: all three methods can be used in the treatment of exogenous CSP. Transvaginal subuterine pregnancy focus resection is superior to uterine artery embolization combined with uterine laparoscopy and laparoscopic pregnancy focus resection.
【作者單位】： 四川省人民醫(yī)院;
【分類號(hào)】：R714.22

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