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目的探讨宫腔镜在Ⅰ型剖宫产瘢痕妊娠(CSP)诊治中的临床价值。方法 113例经阴道超声提示Ⅰ型CSP患者,根据其自主选择的手术方式分为A组(63例)与B组(50例)。A组患者行双侧子宫动脉栓塞术,术后24 h在B超监护下行清宫术;B组行宫腔镜检查,在宫腔镜直视下切除妊娠组织并电凝止血。比较两组临床疗效。结果 B组术中出血量(17.9±4.7)ml、血β-人绒毛膜促性腺激素(β-HCG)降至正常时间(17.9±3.5)d、住院费用(9494.2±499.4)元、护理费用(336.2±21.0)元、住院时间(5.6±0.5)d、月经减少10例,均明显优于A组(30.9±8.1)ml、(20.6±3.3)d、(15031.0±567.3)元、(434.6±24.2)元、(6.5±0.5)d、48例,差异均具有统计学意义(P<0.05);两组患者手术时间及月经复潮时间比较差异无统计学意义(P>0.05)。A组发生盆腔疼痛例数多于B组,差异有统计学意义(P<0.05)。结论与双侧子宫动脉栓塞术联合清宫术相比,宫腔镜直视下切除妊娠组织处理Ⅰ型CSP术中出血量少,恢复快,对术后月经及生育能力影响小,住院费用低,是治疗Ⅰ型CSP较理想的方法。
Objective To investigate the clinical value of hysteroscopy in the diagnosis and treatment of type Ⅰ cesarean scar pregnancy (CSP). Methods One hundred and thirteen patients with type Ⅰ CSP who underwent transvaginal sonography were divided into group A (n = 63) and group B (n = 50) according to their choice of operation. A group of patients underwent bilateral uterine artery embolization, 24 h after surgery undergoing B-ultrasonography; Palace B group underwent hysteroscopy, hysteroscopic removal of pregnancy tissue and coagulation and hemostasis. The clinical efficacy of the two groups were compared. Results The intraoperative blood loss (17.9 ± 4.7) ml, blood β-human chorionic gonadotropin (β-HCG) decreased to normal time (17.9 ± 3.5) d, hospitalization cost (9494.2 ± 499.4) (336.2 ± 21.0) yuan, hospital stay (5.6 ± 0.5) d and menstruation decreased by 10 (30.9 ± 8.1) ml, (20.6 ± 3.3) days and (15031.0 ± 567.3) ± 24.2) yuan, (6.5 ± 0.5) d and 48 cases respectively. The difference was statistically significant (P <0.05). There was no significant difference between the two groups in the operation time and the time of menstrual resuscitation (P> 0.05). There were more cases of pelvic pain in group A than in group B, the difference was statistically significant (P <0.05). Conclusions Compared with bilateral uterine artery embolization combined with hysteroscopic surgery, hysteroscopic resection of pregnancy tissue treated with type Ⅰ CSP less blood loss, rapid recovery, postoperative menstrual and fertility, the cost of hospitalization is low, Is the ideal type CSP treatment method.