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目的:探讨子宫动脉栓塞术后经阴道与经宫腔镜治疗外生型剖宫产瘢痕妊娠(CSP)的临床疗效。方法:回顾性分析2013年10月至2015年5月哈尔滨医科大学附属第一医院收治的56例确诊为外生型CSP患者的临床资料,其中26例行子宫动脉栓塞术后经阴道切除外生型瘢痕妊娠病灶(经阴道手术组),30例行子宫动脉栓塞术后经宫腔镜切除外生型瘢痕妊娠病灶(经宫腔镜手术组)。比较两组患者的手术成功率、术中出血量、术后住院时间、住院费用、血HCG下降至正常时间及不良反应的发生情况等。结果经阴道手术组26例患者手术全部成功成功率为100%。经宫腔镜手术组30例患者中22例手术成功,8例因术中子宫穿孔改行腹腔镜或经腹外生型瘢痕妊娠病灶切除及子宫修补成功率为73.3%显著低于经阴道手术组差异有统计学意义(P<0.05)。经阴道手术组患者的术中出血量[(20.58±6.1)mL]及住院费用((8833.04±491.5)元)明显低于经宫腔镜手术组[(69.03±7.8)mL](P<0.001)、(14908.79±325.5)元(P<0.001)。结论:子宫动脉栓塞术后经阴道与经宫腔镜两种术式均能达到较理想的治疗效果;经阴道治疗外生型CSP可行性强于经宫腔镜手术更安全、有效,值得临床推广。
Objective: To investigate the clinical efficacy of transvaginal and hysteroscopic cesarean scar pregnancy (CSP) after uterine artery embolization. Methods: The clinical data of 56 patients with exogenous CSP admitted to the First Affiliated Hospital of Harbin Medical University from October 2013 to May 2015 were retrospectively analyzed. Twenty-six of 26 patients underwent transvaginal resection of uterine artery after embolization Type of scar pregnancy (vaginal surgery group), 30 cases of uterine artery embolization after hysteroscopic excision of exogenous scar pregnancy lesions (hysteroscopic surgery group). The success rate of surgery, blood loss, postoperative hospital stay, hospitalization costs, blood HCG decreased to normal time and the incidence of adverse reactions were compared between the two groups. Results In the vaginal surgery group, the success rate of all the surgeries was 100%. Among the 30 patients who underwent hysteroscopic surgery, 22 cases were successfully operated, 8 cases achieved complete resection of the lesion and uterine repair due to peritoneal laparoscopy or peritoneal scar formation, and the success rate was 73.3%, which was significantly lower than that of transvaginal operation group The difference was statistically significant (P <0.05). The intraoperative blood loss (20.58 ± 6.1) mL and hospitalization cost (8833.04 ± 491.5) in the transvaginal group were significantly lower than those in the hysteroscopic group (69.03 ± 7.8) mL (P <0.001) ), (14908.79 ± 325.5) yuan (P <0.001). CONCLUSION: Transvaginal and hysteroscopic surgical procedures after uterine artery embolization can both achieve satisfactory therapeutic effect. Transvaginal treatment of exogenous CSP is more safe and effective than hysteroscopic surgery, and is worth clinical Promotion.