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目的探讨经阴道子宫下段妊娠病灶切除术治疗外生型剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的临床效果。方法选取2011年2月至2016年1月在深圳市福田区妇幼保健院及深圳市妇幼保健院就诊的外生型CSP患者66例,其中使用经阴道子宫下段妊娠病灶切除术的30例患者为研究组,采用经腹子宫瘢痕妊娠病灶切除术的36例患者为对照组。比较两组患者的手术情况、术后恢复情况和术后不良反应发生情况。结果研究组患者手术时间、术中出血量、住院时间、住院费用都少于对照组,两组比较差异有统计学意义(P<0.05);研究组患者术后肛门排气时间短于对照组,差异有统计学意义(P<0.05);两组人绒毛膜促性腺激素恢复至正常水平时间、月经复潮时间、病灶缩小时间比较,差异无统计学意义(P>0.05);研究组患者切口液化、阴道流血、周围组织受损等不良反应发生情况均少于对照组,差异有统计学意义(P<0.05)。结论经阴道子宫下段妊娠病灶切除术治疗外生型CSP的临床效果优于经腹子宫瘢痕妊娠病灶切除术,患者损伤小,术后恢复快,不良反应少,值得临床选用。
Objective To investigate the clinical effect of cesarean scar pregnancy (CSP) treated by ectopic cesarean section excision of vaginal uterine segment. Methods From February 2011 to January 2016, 66 cases of exogenous CSP patients were treated in Futian District Maternal and Child Health Hospital of Shenzhen City and Shenzhen Maternal and Child Health Hospital. Among them, 30 patients underwent resection of vaginal uterine segment pregnancy In the study group, 36 patients who underwent resection of aborted abdominal scar pregnancy were selected as the control group. The operation conditions, postoperative recovery and postoperative adverse reactions were compared between the two groups. Results The operation time, intraoperative blood loss, hospitalization time and hospitalization cost of the study group were less than those of the control group, with significant difference between the two groups (P <0.05). The anal exhaust time in the study group was shorter than that in the control group (P <0.05). There was no significant difference between the two groups in the recovery of human chorionic gonadotropin to normal level, the time of menstrual resuscitation and the lessening time of the lesion (P> 0.05). In the study group Incision liquefaction, vaginal bleeding, the surrounding tissue damage and other adverse reactions were less than the control group, the difference was statistically significant (P <0.05). Conclusion The clinical effect of transvaginal uterine segment excision of pregnancy in the treatment of exogenous CSP is better than that of transabdominal uterine scar pregnancy. The patients have less injury, faster recovery and fewer side effects. It is worthy of clinical application.