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腹腔镜切除治疗外源性剖宫产瘢痕妊娠的疗效评价。

Evaluation of the efficacy of laparoscopic resection for the management of exogenous cesarean scar pregnancy.

机构信息

Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China.

Shenyang Women's and Children's Hospital, Shenyang, People's Republic of China.

出版信息

Fertil Steril. 2014 May;101(5):1501-7. doi: 10.1016/j.fertnstert.2014.01.045. Epub 2014 Mar 19.

Abstract

OBJECTIVE

To retrospectively analyze the clinical data of 71 patients with exogenous cesarean scar pregnancy (CSP) treated in our hospital in the past 2 years, to compare the outcomes of exogenous CSP treated with different methods, and to evaluate the safety and feasibility of laparoscopic resection of exogenous CSP.

DESIGN

Comparative observational study.

SETTING

Tertiary medical centers.

PATIENT(S): 71 women with exogenous cesarean scar pregnancy.

INTERVENTION(S): Hysteroscopic resection of CSP, and laparoscopic resection of CSP.

MAIN OUTCOME MEASURE(S): Operation time, intraoperative blood loss, postoperative drainage of the uterine cavity, postoperative days in hospital, time for β-human chorionic gonadotropin (β-hCG) to return to normal levels, absorption time of the mass.

RESULT(S): For the laparoscopic group, the time for serum β-hCG to return normal levels and the postoperative drainage of the uterine cavity were significantly lower than in the patients who had undergone hysteroscopic resection. We found no statistically significant difference in the intraoperative blood loss and postoperative days in hospital between the two groups, but the operation time was longer in laparoscopic group.

CONCLUSION(S): Laparoscopic surgery for a cesarean scar pregnancy has the advantages of a high success rate, fewer complications, and a shorter time for β-hCG levels to normalize. This procedure is especially suitable for the treatment of exogenous CSP.

摘要

目的

回顾性分析 2 年来我院收治的 71 例外生型剖宫产瘢痕妊娠(CSP)患者的临床资料,比较不同方法治疗外生型 CSP 的效果,评价腹腔镜切除外生型 CSP 的安全性和可行性。

设计

对比观察性研究。

单位

三级甲等医院。

对象

71 例外生型剖宫产瘢痕妊娠患者。

干预

采用宫腔镜下妊娠物切除术、腹腔镜下妊娠物切除术。

主要观察指标

手术时间、术中出血量、术后宫腔引流、住院天数、血β-人绒毛膜促性腺激素(β-hCG)恢复正常时间、包块吸收时间。

结果

腹腔镜组血清β-hCG 恢复正常时间和术后宫腔引流均明显低于宫腔镜组,差异有统计学意义(P <0.05);两组术中出血量和住院天数比较差异无统计学意义(P >0.05),但腹腔镜组手术时间长于宫腔镜组,差异有统计学意义(P <0.05)。

结论

腹腔镜手术治疗剖宫产瘢痕妊娠成功率高,并发症少,血β-hCG 恢复正常时间短,尤其适用于外生型 CSP 的治疗。

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