Lu Hai-yan, Zhang Wen-hua, Shan Jun, Tian Qi-shan, Zhang Xiu-qing, Wu Li-chun, Zhou Yan-xia, Li Sai, Peng Yi-mei, Li Dong, Hu Li-na
Department of Obstetrics and Gynecology, Anshan Women and Children Hospital, Anshan, China.
Zhonghua Fu Chan Ke Za Zhi. 2011 Dec;46(12):917-22.
To study clinical efficacy on cesarean scar pregnancy (CSP) treated by transvaginal surgery.
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.
All cases 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.
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.
探讨经阴道手术治疗剖宫产瘢痕妊娠（CSP）的临床疗效。
2008年1月至2011年3月，鞍山市妇儿医院对31例CSP患者行经阴道手术治疗。根据超声检查及术中病变暴露情况，采取不同的手术方式。A组15例行病灶清除切除及子宫壁阴道修补术，B组7例行经阴道子宫动脉结扎加刮宫术，C组9例行子宫下段前壁切开修补术。分析三组术中出血量、手术时间、住院时间、术后血hCG波动情况及并发症。
三组患者均一次治愈。（1）A组术中出血量为（41±21）ml，B组为（27±7）ml，C组为（148±132）ml。A组与B组术中出血量差异无统计学意义（P>0.05），但C组出血量明显多于A组和B组（P<0.05）。（2）A组平均手术时间、平均住院时间、术后血hCG恢复时间分别为（40±11）分钟、（4.7±0.8）天、（2.7±1.0）周；B组分别为（44±5）分钟、（4.0±0.8）天、（2.9±1.0）周；C组分别为（40±12）分钟、（4.9±1.0）天、（2.8±0.9）周。三组上述临床指标差异无统计学意义（P>0.05）。（3）三组均未观察到膀胱损伤等并发症。
经阴道手术治疗CSP疗效确切、操作简便、保留子宫、安全经济。A组手术适用于早期及外生型病灶；B组手术适用于内生型病灶；C组手术适用于A、B组治疗失败的病例，但创伤大于A、B组。
