阴式剖宫产瘢痕妊娠病灶切除术及子宫瘢痕修补术的临床效果分析
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摘要
目的:探讨阴式剖宫产瘢痕妊娠病灶切除术及子宫瘢痕修补术治疗子宫瘢痕妊娠的临床应用价值。方法:回顾性分析笔者所在医院2014年4月-2018年6月行阴式剖宫产瘢痕妊娠病灶切除术及子宫瘢痕修补术的28例患者的临床资料。结果:除1例因病灶直径太大改开腹手术,以及另1例因切口位置高无法缝合改腹腔镜下缝合外,其余26例均手术顺利。手术时间平均(64.46±21.99)min,术中出血量平均(176.33±73.04)ml,下床活动时间平均(8.37±1.04)h,术后住院天数平均(5.08±0.84)d,住院费用平均(7 263.22±1 650.11)元,术后血β-h CG恢复正常时间平均(16±5)d,月经复潮时间平均(30.46±6.05)d。结论:阴式剖宫产瘢痕妊娠病灶切除术及子宫瘢痕修补术是一种安全、有效、微创、经济的治疗方法,值得临床应用推广。
Objective:To explore the clinical value of vaginal cesarean scar pregnancy focus resection and uterine scar repair in the treatment of uterine scar pregnancy.Method:The clinical data of 28 patients who underwent vaginal cesarean scar pregnancy focus resection and uterine scar repair from April 2014 to June 2018 were retrospectively analyzed.Result:Except for one case who underwent laparotomy because of the focal diameter was too large and one case who could not be sutured because of the high incision position,all the other 26 cases were successfully operated.The average operation time was(64.46±21.99)min,the average amount of bleeding during the operation was(176.33±73.04)ml,the average time of getting out of bed was(8.37±1.04)h,the average hospitalization days were(5.08±0.84)d,the average hospitalization cost was(7 263.22±1 650.11)yuan,and the average time of recovering blood β-hCG after the operation were(16±5)d.The average time of menstruation were(30.46±6.05)d.Conclusion:Vaginal cesarean scar pregnancy focus resection and uterine scar repair is a safe,effective,minimally invasive and economical treatment method,which is worthy of clinical application and promotion.
Objective:To explore the clinical value of vaginal cesarean scar pregnancy focus resection and uterine scar repair in the treatment of uterine scar pregnancy.Method:The clinical data of 28 patients who underwent vaginal cesarean scar pregnancy focus resection and uterine scar repair from April 2014 to June 2018 were retrospectively analyzed.Result:Except for one case who underwent laparotomy because of the focal diameter was too large and one case who could not be sutured because of the high incision position,all the other 26 cases were successfully operated.The average operation time was(64.46±21.99)min,the average amount of bleeding during the operation was(176.33±73.04)ml,the average time of getting out of bed was(8.37±1.04)h,the average hospitalization days were(5.08±0.84)d,the average hospitalization cost was(7 263.22±1 650.11)yuan,and the average time of recovering blood β-hCG after the operation were(16±5)d.The average time of menstruation were(30.46±6.05)d.Conclusion:Vaginal cesarean scar pregnancy focus resection and uterine scar repair is a safe,effective,minimally invasive and economical treatment method,which is worthy of clinical application and promotion.
引文
[1]谢幸,孔北华.妇产科学[M].北京:人民卫生出版社,2018:80-81.
[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[J].中华妇产科杂志,2016,51(8)568-572.
[3]袁岩,戴晴,蔡胜,等.超声在剖宫产瘢痕妊娠诊断的诊断价值[J].中华超声影像学杂志,2010,19(4):321-324.
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[6]Maymon R,Halperin R,Mendlovic S,et al.Ectopic pregnancies in caesarean scar:review of the medical approachto an iatrogenic complication[J].Hum Reprod Update,2004,10(6):515-523.
[7]Fylstra D L.Ectopic pregnancy within a cesarean scar:areview[J].Obstet Gynecol Surv,2002,57(8):537-543.
[8]Liu S,Sun J,Cai B,et al.Management of cesarean sear pregnancy using ultrasound-guided dilation and curettage[J].J Minim Invasive Gynecol,2016,23(5):707-711.
[9]李源,向阳,万希润,等.包块型剖宫产术后子宫瘢痕妊娠39例临床分析[J].中华妇产科杂志,2014,49(1):10-13.
[10]ACOG Practice Bulletin No.94:Medical management of ectopic pregnancy[J].Obstetrics and Gynecology,2008,111(6):1479-1485.
[11]乐爱文,单莉莉,肖天慧,等.经阴道前穹隆的剖宫产瘢痕妊娠病灶清除术[J].中国微创外科杂志,2012,12:811-813.
[12]Huanxiao Z,Shuqin C,Hongye J,et al.Transvaginal hysterotomy for cesarean scar pregnancy in 40 consecutive cases[J].Gynecol Surg,2015,12(1):45-51.
[13]周留林,杨纪实,印慧琴,等.腹腔镜辅助阴式子宫瘢痕妊娠病灶切除的应用研究[J].实用临床医药杂志,2017,21(24):84-85.
[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[J].中华妇产科杂志,2016,51(8)568-572.
[3]袁岩,戴晴,蔡胜,等.超声在剖宫产瘢痕妊娠诊断的诊断价值[J].中华超声影像学杂志,2010,19(4):321-324.
[4]Litwicka K,Greco E.Caesarean scar pregnancy:a review of management options[J].Current Opinion in Obstetrics&Gynecol,2013,25(6):456-461.
[5]Seow K M,Huang L W,Lin Y H,et al.Cesarean scar pregnancy:issues in management[J].Ultrasound Obstet Gynecol,2004,23(3):247-253.
[6]Maymon R,Halperin R,Mendlovic S,et al.Ectopic pregnancies in caesarean scar:review of the medical approachto an iatrogenic complication[J].Hum Reprod Update,2004,10(6):515-523.
[7]Fylstra D L.Ectopic pregnancy within a cesarean scar:areview[J].Obstet Gynecol Surv,2002,57(8):537-543.
[8]Liu S,Sun J,Cai B,et al.Management of cesarean sear pregnancy using ultrasound-guided dilation and curettage[J].J Minim Invasive Gynecol,2016,23(5):707-711.
[9]李源,向阳,万希润,等.包块型剖宫产术后子宫瘢痕妊娠39例临床分析[J].中华妇产科杂志,2014,49(1):10-13.
[10]ACOG Practice Bulletin No.94:Medical management of ectopic pregnancy[J].Obstetrics and Gynecology,2008,111(6):1479-1485.
[11]乐爱文,单莉莉,肖天慧,等.经阴道前穹隆的剖宫产瘢痕妊娠病灶清除术[J].中国微创外科杂志,2012,12:811-813.
[12]Huanxiao Z,Shuqin C,Hongye J,et al.Transvaginal hysterotomy for cesarean scar pregnancy in 40 consecutive cases[J].Gynecol Surg,2015,12(1):45-51.
[13]周留林,杨纪实,印慧琴,等.腹腔镜辅助阴式子宫瘢痕妊娠病灶切除的应用研究[J].实用临床医药杂志,2017,21(24):84-85.