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目的评价3种不同手术方法治疗剖宫产后子宫瘢痕处妊娠(CSP)的效果。方法回顾性分析2008年1月-2014年10月就诊于郑州大学第二附属医院妇科并住院行手术治疗的73例早期CSP患者资料。按手术方式不同分为3组,分别为宫腔镜组31例,腹腔镜组15例,阴式组27例;从术前患者一般资料、围手术期情况(术中出血量、手术时间、术后并发症)、术后恢复情况[血β-人绒毛膜促性腺激素(β-HCG)1个月内恢复至正常的例数、月经恢复时间、阴道流血时间]及住院时间和住院费用等方面进行评价,以期寻求更安全、有效、经济的治疗方式。结果 3组患者的术中出血量、手术时间、术后住院时间和住院费用比较差异有统计学意义(F/H值分别为14.86、45.60、45.51和28.86,P<0.05);3组术后血β-HCG 1个月内恢复至正常例数、月经恢复时间及阴道流血时间比较差异无统计学意义(F/H值分别为0.215、0.08和0.922,P>0.05)。结论 1宫腔镜手术、腹腔镜手术、阴式手术均是治疗CSP的有效方法,避免了子宫切除,保留了患者生育功能;2腹腔镜手术较宫腔镜手术及阴式手术花费高、出血多,阴式手术治疗CSP出血少、损伤小、不受血β-HCG值的影响、恢复快、病灶清除彻底,还有对器械、设备要求不高,费用低的优点,减轻了患者的经济负担,值得临床推广;3各种手术方式的选择要根据妊娠囊大小而定,需要选择合适的病例,所以术前有效的评估显得尤为重要。
Objective To evaluate the effect of three different surgeries on gestational cesarean section pregnancy (CSP) after cesarean section. Methods A retrospective analysis of 73 cases of early-stage CSP patients treated by gynecology and in-hospital surgery at the Second Affiliated Hospital of Zhengzhou University from January 2008 to October 2014 was performed. According to the different surgical methods, the patients were divided into 3 groups: 31 cases in hysteroscopy group, 15 cases in laparoscopic group and 27 cases in vaginal group. According to the general information of preoperative patients, the perioperative conditions (intraoperative blood loss, operation time, Postoperative complications), postoperative recovery (recovery of normal β-HCG within 1 month, menstrual recovery time, vaginal bleeding time), hospitalization and hospitalization costs And other aspects of evaluation, with a view to seeking more secure, effective and economical treatment. Results The blood loss, operation time, postoperative hospital stay and hospitalization cost of the three groups were statistically significant (F / H values were 14.86, 45.60, 45.51 and 28.86, respectively, P <0.05) There was no significant difference between the two groups (P <0.05). The F / H values were 0.215, 0.08 and 0.922, respectively. Conclusion 1 hysteroscopy, laparoscopic surgery, vaginal surgery are effective methods for the treatment of CSP, to avoid the hysterectomy, to retain the patient’s reproductive function; 2 laparoscopic surgery and hysteroscopic surgery than the high cost of surgery, bleeding More, vaginal surgery CSP less bleeding, less damage, free from the impact of blood β-HCG value, rapid recovery, complete removal of the lesion, as well as equipment, equipment, less demanding, low cost advantages and reduce the patient’s economy Burden, worthy of clinical promotion; 3 the choice of various surgical methods according to the size of gestational sac, the need to select the appropriate case, so preoperative effective assessment is particularly important.