[1]高洪波,陈香茹,綦小蓉*,等.腹腔镜与阴式手术治疗III型剖宫产瘢痕妊娠临床疗效观察[J].中国计划生育和妇产科,2020,(5):77-80.
　GAO Hongbo,CHEN Xiangru,QI Xiaorong*,et al.A comparative study on the effects of laparoscopic and transvaginal surgery on type III caesarean scar pregnancy[J].Chinese Journal of Family Planning & Gynecotokology,2020,(5):77-80.
点击复制

腹腔镜与阴式手术治疗III型剖宫产瘢痕妊娠临床疗效观察
分享到：

《中国计划生育和妇产科》[ISSN:1674-4020/CN:51-1708/R]

卷:
期数:
2020年5期
页码:
77-80
栏目:
论著与临床
出版日期:
2020-05-25

文章信息/Info

Title:
A comparative study on the effects of laparoscopic and transvaginal surgery on type III caesarean scar pregnancy
作者:
高洪波1; 陈香茹1; 綦小蓉2*; 王乔2
1.635100四川大竹，大竹县人民医院妇产科；2.610041四川成都，四川大学华西第二医院妇科 出生缺陷与相关妇儿疾病教育部重点实验室
Author(s):
GAO Hongbo1;  CHEN Xiangru1;  QI Xiaorong2*;  WANG Qiao2
1. Department of Obstetrics and Gynecology, Dazhu County People's Hospital, Dazhu Sichuan 635100; 2. Department of Gynecological，Birth Defects and Related Maternal and Child Diseases Key Laboratory of Ministry of Education， West China Second Hospital of Sichuan University, Chengdu Sichuan 610041,P.R.China
关键词:
剖宫产瘢痕妊娠; 子宫切开取胚及缝合术; 腹腔镜; 阴式手术; 切口憩室
Keywords:
cesarean scar pregnancy;  uterine cystectomy and suture;  laparoscopy;  vaginal surgery;  incision diverticulum
分类号:
R 7193+4
摘要:
目的探究腹腔镜与阴式手术治疗III型剖宫产瘢痕妊娠的疗效。方法回顾性分析大竹县人民医院2015年3月至2019年3月收治的54例III型剖宫产瘢痕妊娠患者的临床资料。其中行腹腔镜下子宫切开取胚术的28例为腹腔镜组（A组）,行经阴道子宫切开取胚术的26例为阴式手术组（B组）,术后定期复查至术后6月。对比两组患者术后恢复情况。结果两组患者人绒毛膜促性腺激素下降至正常时间、月经恢复时间比较，差异无统计学意义（P>005）。两组患者手术时间、术中出血量、住院费用、肛门排气时间、住院时间、术后出现阴道异常流血、发生剖宫产子宫切口愈合不良等指标比较，A组数据大于B组，差异均有统计学意义（P<005）。两组患者术后复查瘢痕肌层厚度比较，A组小于B组，差异有统计学意义（P<005）。结论阴式手术治疗III型剖宫产瘢痕妊娠较腹腔镜手术的手术时间短、出血量少，术后恢复快，住院费用低，且术后发生阴道异常流血、切口憩室形成的比例低，瘢痕愈合更好，更有临床优势。
Abstract:
ObjectiveTo compare the effect of laparoscopic and transvaginal surgery on type III cesarean scar pregnancy. MethodsA retrospective analysis of the clinical data of 54 patients with type III caesarean scar pregnancy treated in Dazhu County People's Hospital from March 2015 to March 2019.Among them, 28 cases underwent laparoscopic uterine cystectomy and suture were in laparoscopic group (Group A), 26 cases underwent transvaginal uterine cystectomy and suture were in vaginal operation group(Group B),regular postoperative reviewed to 6 months after surgery. Compared the postoperative recovery of the two groups of patients. ResultsThere were no significant differences between the two groups of patients with hCG dropping to normal time and menstrual recovery time(P>005).In the two groups, there were significant differences in the general indicators such as surgical time, intraoperative bleeding, hospitalization cost, anal exhaust time,hospitalization time，and whether there was abnormal vaginal bleeding after surgery, whether there was bad uterine incision healing after cesarean section, etc.，datas of Group A were significantly larger than Group B ,the differences were statistically significant（P<005）.The thickness of the scar muscular layer after reexamination in group A was significantly smaller than that in group B, with a significant difference (P<005). ConclusionVaginal surgery for type III cesarean scar pregnancy has shorter operation time, less bleeding, faster postoperative recovery, lower hospitalization cost, lower vaginal bleeding after surgery, lower rate of incision diverticulum formation, and better scar healing than laparoscopic surgery, with clinical advantages.

参考文献/References:

［1］Litwicka K, Greco E. Caesarean scar pregnancy: a review of management options ［J］. Current Opinion in Obstetrics & Gynecology, 2011, 23(6): 415421. ［2］中华医学会妇产科学分会计划生育学组．剖宫产术后子宫瘢痕妊娠诊治专家共识(2016) ［J］．全科医学临床与教育，2017，15（1）：59． ［3］吴钟瑜，李慧东，张蕾．剖宫产术后子宫切口瘢痕处憩室的阴道超声诊断 ［J］．中华妇产科杂志，2008，43（6）：452453． ［4］付晓娟．子宫切口瘢痕憩室(PCSD)的彩色多普勒超声形态学改变与异常子宫出血的相关性分析 ［J］．影像研究与医学应用，2018，2（20）：112113． ［5］陈乾，洪莉，胡鸣，等．剖宫产瘢痕妊娠临床诊疗综述 ［J］．中国计划生育和妇产科，2019，11（5）：913． ［6］Zeng Zhen,Ding Shuping,Zeng Xue,et al. The value of transvaginal ultrasound in clinical surgical treatment of cesarean scar pregnancy ［J］. Journal of Huazhong University of Science and Technology(Medical Sciences), 2017, 37(4): 536540. ［7］Seow K M, Huang Lw, Lin Yh, et al. Cesarean scar pregnancy: issues in management ［J］. Ultrasound in Obstetrics & Gynecology:the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology,2004,23(3):247253. ［8］陈洪琴，周容．剖宫产瘢痕部位妊娠的诊治 ［J］．实用妇产科杂志，2018，34（1）：13． ［9］苏翠红．剖宫产子宫切口憩室的诊疗进展 ［J］．实用妇产科杂志，2013，29（4）：262264． ［10］王马列，梁润彩．剖宫产术后子宫切口憩室治疗进展 ［J］．中国实用妇科与产科杂志，2013，29（5）：390392． ［11］柯抒晨，林义，夏晖．剖宫产术后子宫切口憩室形成的危险因素分析 ［J］．中国妇幼保健，2019，34（9）：19941997． ［12］陈思蕾，王丹丹，杨清．剖宫产子宫瘢痕憩室的修复与妊娠安全 ［J］．实用妇产科杂志，2018，34（1）：811． ［13］沈柯炜，张英芝，周欢珍，等．二次剖宫产行子宫瘢痕切除术预防剖宫产切口瘢痕憩室效果的临床研究 ［J］．实用妇产科杂志，2017，33（10）：782785． ［14］骆文香，张鸿慧，崔向华，等．剖宫产瘢痕部位憩室病因研究［J］．中国计划生育学杂志，2018，26（10）：10031007． ［15］Tower A M, Frishman G N. Cesarean scar defects: an underrecognized cause of abnormal uterine bleeding and other gynecologic complications ［J］. Journal of Minimally Invasive Gynecology, 2013, 20(5): 562572. ［16］莫劲思，苏宝兰，梁晓明，等．三种微创手术治疗剖宫产瘢痕妊娠的临床研究 ［J］．齐齐哈尔医学院学报，2018，39（24）：28962898． ［17］卢树辉，单莉莉，肖水秀，等．剖宫产瘢痕妊娠142例临床分析 ［J］．中国微创外科杂志，2016，16（7）：594596, 605． ［18］张连民，赵旭，高儒．不同微创手术治疗剖宫产瘢痕妊娠的疗效比较 ［J］．微创医学，2017，12（6）：816818． ［19］ Ko J K, Li R H, Cheung V Y. Caesarean scar pregnancy: a 10year experience ［J］. The Australian & New Zealand Journal of Obstetrics & Gynaecology, 2015, 55(1): 6469. ［20］热艳古丽·达吾提．经阴道手术治疗剖宫产子宫切口瘢痕憩室的临床疗效及术后憩室再形成的相关因素分析 ［D］．乌鲁木齐：新疆医科大学，2016：144． ［21］徐郑军，刘永莹，张晓平，等．阴式子宫瘢痕妊娠病灶切除+子宫憩室修补术与子宫动脉栓塞术治疗剖宫产瘢痕妊娠的疗效比较 ［J］．蚌埠医学院学报，2016，41（7）：874876.

相似文献/References:

[1]于晓兰.剖宫产瘢痕妊娠的病理特点[J].中国计划生育和妇产科,2013,(04):0.
　YU Xiao-lan.[J].Chinese Journal of Family Planning & Gynecotokology,2013,(5):0.
[2]董海伟,杨晓惠,顾向应,等.超声诊断技术在剖宫产瘢痕妊娠中的应用[J].中国计划生育和妇产科,2013,(04):0.
　DONG Hai-wei,YANG Xiao-hui,GU Xiang-ying *.[J].Chinese Journal of Family Planning & Gynecotokology,2013,(5):0.
[3]王运昌,陈梅,张周龙,等.超声在剖宫产瘢痕妊娠诊断及治疗中的应用价值[J].中国计划生育和妇产科,2014,(04):0.
　WANG Yun-chang,CHEN Mei,ZHANG Zhou-long,et al.[J].Chinese Journal of Family Planning & Gynecotokology,2014,(5):0.
[4]张天宏,史小雨,冯力民,等.宫腹腔镜在剖宫产瘢痕妊娠诊治中的应用[J].中国计划生育和妇产科,2015,(10):0.
[5]刘彩霞,郭宝枝,刘爱珍,等.腹腔镜治疗剖宫产瘢痕妊娠术中中转开腹手术原因分析[J].中国计划生育和妇产科,2015,(11):0.
　LIU Cai-xia,GUO Bao-zhi,LIU Ai-zhen,et al.[J].Chinese Journal of Family Planning & Gynecotokology,2015,(5):0.
[6]闻人昉,熊小娟,丁兴琳,等.剖宫产瘢痕妊娠介入治疗医疗费用特征分析[J].中国计划生育和妇产科,2016,(02):0.
　WEN Ren-fang,XIONG Xiao-juan,DIN Xing-lin,et al.[J].Chinese Journal of Family Planning & Gynecotokology,2016,(5):0.
[7]石一复,郝敏,李娟清,等.7所医学院校附属医院2010～2014年正常和异常妊娠浅析[J].中国计划生育和妇产科,2016,(06):0.
　SHI Yi-fu,HAO Min,LI Juan-qing,et al.[J].Chinese Journal of Family Planning & Gynecotokology,2016,(5):0.
[8]王新波,谢玉翠,王来栋,等.3种方案用于剖宫产瘢痕妊娠药物治疗大出血的对比观察[J].中国计划生育和妇产科,2016,(11):0.
　WANG Xin-Bo,XIE Yu-Cui,WANG Lai-Dong,et al.[J].Chinese Journal of Family Planning & Gynecotokology,2016,(5):0.
[9]石一复*,郝敏,李娟清,等.7所医学院校附属医院2010~2014年正常和 异常妊娠浅析[J].中国计划生育和妇产科,2016,(6):6.
　SHI Yi-fu*,HAO Min,LI Juan-qing,et al.Analysis of normal and abnormal pregnancies in 7 affiliated hospitals of medical colleges between 2010 and 2014[J].Chinese Journal of Family Planning & Gynecotokology,2016,(5):6.
[10]韩艳*,张俊娣,杨露.子宫动脉栓塞术对剖宫产瘢痕妊娠清宫效果的影响及安全性[J].中国计划生育和妇产科,2017,(2):29.
　HAN Yan*,ZHANG Jun-di,YANG Lu.Effect of uterine arterial embolization on the effect of uterus clearing of cesarean section scar pregnancy and its safety[J].Chinese Journal of Family Planning & Gynecotokology,2017,(5):29.

更新日期/Last Update: 2020-05-25