宫、腹腔镜联合治疗瘢痕妊娠后子宫内膜恢复程度及远期妊娠观察

目的:探讨宫腔镜联合腹腔镜治疗外生型瘢痕妊娠对患者子宫内膜及远期妊娠情况的影响。方法:将64例外生型瘢痕妊娠患者随机分为两组,观察组(n=32)接受宫腔镜联合腹腔镜手术治疗,对照组(n=32)接受经阴道孕囊注射甲氨蝶呤联合清宫术治疗。对比分析两组手术效果、术后6个月瘢痕形态与残余肌层情况、再次妊娠情况。结果:观察组术中出血量、住院时间、月经复常时间、阴道流血时间、绒毛膜促性腺激素转阴时间优于对照组(P0.05);术后6个月瘢痕长度、宽度及深度观察组均小于对照组,瘢痕处残余肌层厚度及比例高于对照组(P0.05);观察组瘢痕憩室类型优于对照组(P0.05)。随访期间,观察组并发症发生率低于对照组(P0.05)。结论:外生型瘢痕子宫患者应用宫腔镜联合腹腔镜治疗可有效促进瘢痕愈合、子宫内膜恢复,对改善远期妊娠结局有一定作用。

Effect of laparoscopy combined with hysteroscopy on endometrial recovery and long term reproduction in the treatment of ce-sarean scar pregnancy

Objective:To investigate the effect of hysteroscopy combined with laparoscopy on endometrial recovery and long term reproduction in the treatment of patients with exogenous cesarean scar pregnancy. Methods:Sixty-four patients with exogenous ce-sarean scar pregnancy were randomly divided into 2 groups. 32 patients in the observation group were treated with hysteroscopy com-bined with laparoscopy,while the other 32 patients in the control group were treated with methotrexate injection through vagina combined with uterine curettage. The clinical effect of surgery,scar formation and residual muscle layer at 6 months after surgery,and long term reproduction information in 2 groups were compared. Results:Compared with the control group,intraoperative bleeding in the observa-tion group was significantly less,and hospitalization time,menstrual recovery time,vaginal bleeding time and human chorionic gonado-tropin clearance time in the observation group were significantly shorter (P<0. 05). The length,width and depth of the scar in observa-tion group at 6 months after surgery were significantly less than those of the control group (P<0. 05). The thickness and the proportion of residual muscle layer in the observation group were significantly higher than those in the control group (P<0. 05). Scar formation in the observation group was significantly better than that in the control group (P<0. 05). During follow-up,the proportion of total adverse events of reproduction in the observation group was significantly less than that in the control group (P<0. 05). Conclusions:The appli-cation of hysteroscopy combined with laparoscopy in the treatment of exogenous cesarean scar pregnancy can effectively promote the healing of scar and restore the endometrium,thus it is effective in the improvement of long-term outcome of reproduction.