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目的探讨剖宫产瘢痕妊娠(CSP)不同临床类型的治疗结果。方法回顾性分析50例CSP患者的临床资料。结果 50例患者均保留了生育功能。2例保守治疗的内生型CSP患者,治疗1周后绒毛及蜕膜样组织自阴道排出,影像学和实验室检查显示病情解除。采用清宫术治疗时,内生型CSP患者手术时间、术中出血量显著少于外生型CSP患者(P<0.05)。采用宫腔镜电切术治疗时,内生型CSP患者手术时间、术中出血量、住院时间显著少于外生型CSP患者(P<0.05)。结论对于保守治疗无效的患者,内生型CSP可酌情考虑清宫术,外生型CSP更多的可考虑腔镜切除术。从减少二次处理的角度来看,阴式病灶切除术具有更大的临床优势,但其适用范围还有待进一步探讨。
Objective To investigate the outcomes of different clinical types of cesarean scar pregnancy (CSP). Methods The clinical data of 50 patients with CSP were retrospectively analyzed. Results All 50 patients retained fertility. 2 cases of conservative treatment of endogenous CSP patients, 1 week after treatment villi and decidual tissue from the vaginal discharge, imaging and laboratory tests showed that the disease was relieved. During the treatment of endometrial CSP, the operation time and intraoperative blood loss were significantly less than those of exogenous CSP patients (P <0.05). Hysteroscopic electrosurgical treatment of endogenous CSP patients with surgery time, blood loss, hospitalization time was significantly less than the exogenous CSP patients (P <0.05). Conclusions For conservative treatment of patients with ineffective endoscopic CSP can be considered discretion Qing Gong surgery, exogenous CSP can be considered more endoscopic resection. From the reduction of secondary treatment point of view, vaginal lesion resection has a greater clinical advantage, but its scope of application remains to be further explored.