有生育要求的Ⅲ型CSP手术治疗效果临床研究

Clinical study on the effect of surgical treatment of typeⅢCSP patients with fertility requirements

摘要:

目的： 探讨有生育要求的Ⅲ型瘢痕妊娠（cesarean scar pregnancy，CSP）阴式及腹腔镜病灶切除修补术（focal excision repair，FER）手术方式的临床价值。方法： 回顾分析2017年1月至2019年12月重庆市妇幼保健院收治的有生育要求的Ⅲ型CSP并行非介入辅助下阴式FER 55例及腹腔镜FER 36例。结果： 88例手术顺利，阴式FER术中出血（116.6±33.3）mL，手术时间（68.0±13.3）min，腹腔镜FER术中出血（150.6±31.6）mL，手术时间（107.0±13.3）min；2种手术出血量和手术时间统计学差异明显（P<0.05），阴式FER住院费用明显低于腹腔镜FER（P<0.05），术后1年超声随访阴式FER切口瘢痕厚度[（4.66±0.30）mm]较腹腔镜FER[（4.06±0.37）mm]厚（P<0.05），术后18个月后妊娠情况无统计学差异（P>0.05）。结论： 2种手术方式治疗Ⅲ型CSP各有利弊，非紧急情况下可以避免使用子宫动脉栓塞术（uterus artery embolization，UAE）。

Abstract:

Objective: To explore the clinical treatment effects of two surgical methods of typeⅢcesarean scar pregnancy (CSP) vaginal and laparoscopic focal excision repair (FER) with fertility requirements. Methods: Retrospective analysis was made on 55 cases of typeⅢCSP with fertility requirements taking non-invasive assisted vaginal FER and 36 cases of laparoscopic FER admitted to Chongqing Health Center for Women and Children from January 2017 to December 2019. Results: The operation went smoothly among 88 cases. The bleeding during vaginal FER operation was (116.6±33.3) mL, and the operation time was (68.0±13.3) min; the bleeding during laparoscopic FER operation was (150.6±31.6) mL, and the operation time was (107.0±13.3) min. There were significant differences in the bleeding volume and operation time among the two kinds of operations (P<0.05). The hospitalization cost of vaginal FER was significantly lower than that of laparoscopic FER (P<0.05). The scar thickness of female FER incision [(4.66±0.30) mm]was significantly greater than that of laparoscopic FER [(4.06±0.37) mm]in one-year of ultrasound follow-up after operation (P<0.05), and there was no significant difference in pregnancy after 18 months (P>0.05). Conclusion: There are advantages and disadvantages of the two surgical methods for typeⅢCSP, and uterus artery embolization (UAE) can be avoided in non-emergency situations.