实用医院临床杂志
實用醫院臨床雜誌
실용의원림상잡지
PRACTICAL JOURNAL OF CLINICAL MEDICINE
2015年
4期
107-109
,共3页
剖宫产后子宫瘢痕妊娠%改良分型%宫腔镜%腹腔镜
剖宮產後子宮瘢痕妊娠%改良分型%宮腔鏡%腹腔鏡
부궁산후자궁반흔임신%개량분형%궁강경%복강경
Caesarean section scar pregnancy (CSP)%Modified classification%Hysteroscopy%Laparoscopy
目的：探讨剖宫产后子宫瘢痕妊娠（CSP）的改良分型对其治疗的指导意义。方法我院2010年7月至2013年1月收治39例 CSP 患者，根据子宫瘢痕妊娠的改良分型选择治疗方法，Ⅰ型采用药物治疗加清宫手术或宫腔镜手术；Ⅱa型采用药物治疗、宫腔镜手术、腹腔镜手术或宫腹腔镜联合手术；Ⅱb 型采用经腹或腹腔镜下子宫修补术，不采用或不单独采用宫腔镜手术。结果3种分型治疗的术中出血量两两比较差异有统计学意义（P ＜0．05），而住院时间和血β－hCG 水平恢复时间3种分型治疗的差异均无统计学意义（P ＞0．05）。除1例单纯药物治疗外，其余病例均由术中确诊，输血治疗1例。曾表现为院内外人流术中大出血者Ⅰ型2例，Ⅱa 型1例，Ⅱb 型4例。各型均无子宫切除病例。结论根据子宫瘢痕妊娠的改良分型选择治疗方法，针对性强，效果可靠，预后良好。
目的：探討剖宮產後子宮瘢痕妊娠（CSP）的改良分型對其治療的指導意義。方法我院2010年7月至2013年1月收治39例 CSP 患者，根據子宮瘢痕妊娠的改良分型選擇治療方法，Ⅰ型採用藥物治療加清宮手術或宮腔鏡手術；Ⅱa型採用藥物治療、宮腔鏡手術、腹腔鏡手術或宮腹腔鏡聯閤手術；Ⅱb 型採用經腹或腹腔鏡下子宮脩補術，不採用或不單獨採用宮腔鏡手術。結果3種分型治療的術中齣血量兩兩比較差異有統計學意義（P ＜0．05），而住院時間和血β－hCG 水平恢複時間3種分型治療的差異均無統計學意義（P ＞0．05）。除1例單純藥物治療外，其餘病例均由術中確診，輸血治療1例。曾錶現為院內外人流術中大齣血者Ⅰ型2例，Ⅱa 型1例，Ⅱb 型4例。各型均無子宮切除病例。結論根據子宮瘢痕妊娠的改良分型選擇治療方法，針對性彊，效果可靠，預後良好。
목적：탐토부궁산후자궁반흔임신（CSP）적개량분형대기치료적지도의의。방법아원2010년7월지2013년1월수치39례 CSP 환자，근거자궁반흔임신적개량분형선택치료방법，Ⅰ형채용약물치료가청궁수술혹궁강경수술；Ⅱa형채용약물치료、궁강경수술、복강경수술혹궁복강경연합수술；Ⅱb 형채용경복혹복강경하자궁수보술，불채용혹불단독채용궁강경수술。결과3충분형치료적술중출혈량량량비교차이유통계학의의（P ＜0．05），이주원시간화혈β－hCG 수평회복시간3충분형치료적차이균무통계학의의（P ＞0．05）。제1례단순약물치료외，기여병례균유술중학진，수혈치료1례。증표현위원내외인류술중대출혈자Ⅰ형2례，Ⅱa 형1례，Ⅱb 형4례。각형균무자궁절제병례。결론근거자궁반흔임신적개량분형선택치료방법，침대성강，효과가고，예후량호。
Objective To investigate the treatment guiding significance of a modified classification of caesarean section scar pregnancy (CSP).Methods Clinical data of 39 CSP cases were analyzed retrospectively .The patients were admitted to our hospital during the period from July 2010 to January 2013.They were treated with different therapeutic regimens according to the CSP modified classification.The patients with type ⅠCSP were treated with medication and dilation and curettage or hysteroscopy .The patients with type Ⅱa were treated with medication,hysteroscopy,laparoscopy or laparoscopy combined with hysteroscopy .The patients with type Ⅱb were treated with transabdominal or laparoscopic uterine repair but not hysteroscopy .Results There were significant differences in intr -aoperative blood loss among the 3 groups.The difference of average hospital day and average recovery time of serum β-hCG was not sig-nificantly different.Except one case with simple medication,the diagnosis was all confirmed by surgery .One patient received the blood infusion.There were 2 cases in the type Ⅰ group,1 case in the Ⅱa group and 4 cases in the Ⅱb group showed a heavy vaginal bleeding during dilation and curettage.All patients were cured successfully without any hysterectomy .Conclusion The modified classification of CSP plays a directive role in guiding treatment options .The effect is reliable and the prognosis may be fairly good .
