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目的探讨宫腹腔镜联合在子宫瘢痕部位妊娠手术中的应用价值。方法回顾性分析2011年7月至2015年1月在郑州市第一人民医院妇产科就诊的80例剖宫产术后子宫瘢痕妊娠患者,其中A组40例行宫腹腔镜联合下病灶清除术+子宫修补术;B组40例行介入治疗,术后24 h行清宫术。结果 A组均在宫腹腔镜联合下完成手术,无一例中转开腹、出血或子宫穿孔;B组4例患者因双侧子宫动脉栓塞术后清宫术中子宫瘢痕部位穿孔行修补术,3例因术后复查彩超宫内残留行二次清宫术。A组患者术中平均出血量、手术并发症、平均住院日及住院费用均低于B组患者,差异有统计学意义(P<0.05)。结论宫腹腔镜联合在处理子宫瘢痕部位妊娠手术中具有疗效确切、手术创伤小、相比较介入治疗手术费用低、住院时间短、安全性好、并发症少、出血量较低等优点,是治疗子宫瘢痕妊娠的较理想方法。
Objective To investigate the value of hysteroscope combined with laparoscopy in the pregnancy of uterine scar. Methods A retrospective analysis of 80 patients with uterine scar pregnancy after cesarean section was conducted in the Obstetrics and Gynecology Department of First People’s Hospital of Zhengzhou City from July 2011 to January 2015. A group of 40 cases underwent laparoscopic combined debridement + Uterine repair; B group of 40 cases of interventional therapy, curettage 24 h after surgery. Results All the patients in Group A underwent laparoscopic surgery without laparotomy, hemorrhage or uterine perforation. In Group B, 4 patients underwent uterine scar perforation after radical uterine artery embolization in 3 patients Postoperative recollection of color residual intrauterine residual line second curettage. The mean intraoperative blood loss, operative complications, average length of stay and hospitalization in group A were significantly lower than those in group B (P <0.05). Conclusions Hysteroscope combined with laparoscopic surgery in the treatment of uterine scar pregnancy has the exact effect, less trauma, compared to the interventional treatment of low cost, shorter hospital stay, safety, fewer complications, lower blood loss and so on, is the treatment Womb scar pregnancy is a more ideal method.