经阴道手术治疗剖宫产术后子宫瘢痕妊娠31例临床分析

目的 探讨经阴道手术治疗剖宫产术后子宫瘢痕妊娠(CSP)的临床效果.方法 对鞍山市妇儿医院妇产科2008年1月至2011年3月收治的符合CSP诊断标准的31例患者行经阴道手术治疗,根据其超声检查结果及术中暴露病灶情况,酌情选择不同术式,其中经阴道局部病灶清除术+子宫壁修补术(A组)l5例,经阴道结扎子宫动脉后行刮宫术(B组)7例,经阴道纵向切开宫颈前壁和子宫前壁下段于直视下清除病灶并行子宫修补术(C组)9例.比较各组术中出血量、手术时间、住院时间、术后血hCG恢复正常的时间及并发症发生情况.结果 3组患者均一次性手术成功.(1)术中出血量A组为(41±21) ml、B组为(27±7) ml、C组为(148±132)ml,A、B两组术中平均出血量比较,差异无统计学意义(P＞0.05),而C组术中平均出血量明显多于A、B两组(P＜0.05);(2)手术时间、住院时间、术后血hCG恢复正常时间A组分别为(40±11) min、(4.7±0.8)d和(2.7±1.0)周,B组分别为(44±5) min、(4.0±0.8)d和(2.9±1.0)周,C组分别为(40±12) min、(4.9±1.0)d和(2.8±0.9)周,3组间分别比较,差异均无统计学意义(P＞0.05);(3)3组无一例膀胱损伤等并发症发生.结论 经阴道手术治疗CSP,疗效确切、操作简单、可保留子宫、安全经济,其中A组术式适用于病灶为外生型的早期病例,B组术式适用于病灶为内生型的病例,C组术式适用于前两种术式操作困难或失败的病例,但损伤较前两种术式大.

Study on 31 cases with cesarean scar pregnancy treated by transvaginal surgery

Objective To study clinical efficacy on cesarean scar pregnancy (CSP) treated by transvaginal surgery.Methods From Jan.2008 to Mar.2011,31 cases with CSP were managed by transvaginal surgery in Anshan Women and Children Hospital.Based on ultrasonograpy examination and intraoperative exposure of lesion,variable surgical options were executed.Fifteen cases in group A were treated by debridement resection and vaginal repair of uterine wall,7 cases in group B were treated by transvaginal uterine artery ligation and curettage,9 cases were treated by cutting the anterior wall in the lower uterine segment and repairing uterine.The intraoperative blood loss,operation time,hospital stay,hCG fluctuation at postoperative period and complications were analyzed among those groups.Results Allcases in 3 groups were cured well in one time.( 1 ) The intraoperative blood loss were (41 ±21 ) ml in group A,(27 ±7) ml in group B and ( 148 ± 132) ml in group C.There was no statistically different blood loss between group A and group B ( P ＞ 0.05 ),however,the amount blood loss in group C was significantly more than those in group A and group B ( P ＜ 0.05 ).( 2 ) The average surgical time,the mean hospital stay,postoperative recovery time of blood hCG were (40 ± 11 ) minutes,(4.7 ± 0.8 ) days and ( 2.7 ± 1.0) weeks in group A,(44 ± 5 ) minutes,(4.0 ± 0.8) days and (2.9 ± 1.0) weeks in group B,(40 ± 12) minutes,(4.9 ± 1.0) days and (2.8 ±0.9) weeks in group C.Those clinical index were no statistically different among those 3 groups(P ＞0.05).(3) No bladder injury and other complications were observed in those groups.Conclusions Transvaginal surgery is efficacy,easy to operate,to keep the uterus,safe and economy in treatment of CSP.Surgery in group A is suitable to treat early and exogenous lesions; surgery in group B is suitable to treat endogenous lesions; surgery in group C is suitable to treat failure cases in group A and B,however,the injury is greater than those in group A and B.