腹腔镜下连续褥式内翻缝合治疗外生型剖宫产切口部妊娠的临床研究

Clinical study of laparoscopic continuous inverting mattress suture+suction curettage for exogenous cesarean scar pregnancy

摘要:

目的 探讨经腹腔镜下连续褥式内翻缝合治疗外生型剖宫产切口部妊娠（CSP-Ⅱ）的安全性和有效性。方法 选择2019年1月1日－2020年6月30日在该院就诊的CSP-Ⅱ患者41例，分为A组（实验组，n = 20）和B组（对照组，n = 21）。A组行腹腔镜下连续褥式内翻缝合，B组行腹腔镜下子宫切开取胚术。比较两组患者手术时间、术中出血量、术后第1天血清β-人绒毛膜促性腺激素（β-HCG）值、住院时间、β-HCG转阴时间、术后第1天血红蛋白（HB）值、恢复月经时间、术后第1天较手术前1天血清β-HCG的下降百分率。结果 A组术后第1天β-HCG值较B组高，但两组比较，差异无统计学意义（P > 0.05）；B组住院时间较A组时间长，但两组比较，差异无统计学意义（P > 0.05）；A组β-HCG转阴时间和恢复月经时间较B组长，术后第1天HB值较B组高，两组比较，差异均有统计学意义（P < 0.05）；A组术中出血量少于B组，手术时间短于B组，两组比较，差异有统计学意义（P < 0.05）；两组术后第1天血清β-HCG水平均较术前1天下降50.00%以上。B组瘢痕肌层切除后，行病理检查发现：肌层内存在少许绒毛组织，纤维平滑肌组织间见大量增生的滋养细胞。结论 腹腔镜下连续褥式内翻缝合治疗CSP-Ⅱ具有手术简单、术中出血少、手术时间短、创伤小等优势，可切除憩室、增加子宫下段厚度和缩短避孕时间的优点，但术后血清β-HCG下降缓慢、恢复月经时间长。

Abstract:

Objective To investigate the safety and effectiveness of laparoscopic continuous inverting mattress suture + suction curettage in the treatment of exogenous cesarean scar pregnancy (CSP-Ⅱ).Methods 41 patients with CSP-Ⅱ were selected from January 1 2019 to June 30 2020. They were divided into group A (experiment group, n = 20) and group B (control group, n = 21). Group A underwent laparoscopic continuous inverting mattress suture, Group B underwent laparoscopic hysterotomy. We compared the intraoperative blood loss, operation time, serum β-human chorionic gonadotropin (β-HCG) levels on the first day after operation, time for serum β-hCG levels to return to normal, hemoglobin (HB) on the first day after operation, menstruation recovery time, the decrease rate of serum β-HCG level on the first day after operation compared with 1 day before operation, inpatient time.Results Group A was compared with group B, the serum β-HCG levels on the first day after operation, inpatient time were not statistically significant (P > 0.05); The time for serum β-HCG levels to return to normal and menstruation recovery time in group A were significant longer than those in group B, HB on the first day after operation was significant higher than that in group B, the differences between the two groups were statistically significant (P < 0.05); The intraoperative blood loss in groups A was less than that in group B, the operation time was shorter than that in group B, the difference between the two groups were statistically significant (P < 0.05); The level of serum β-HCG on the first day after operation decreased by more than 50.00% in both groups compared with the 1st preoperative day. In group B, the pathology of the excised scar muscle layer showed that there was a little villus tissue in the muscle layer, and a large number of trophoblast cells were seen between the fibrous smooth muscle tissues.Conclusion Laparoscopic continuous inverting mattress suture+suction curettage in the treatment of CSP-Ⅱ is more simple, less bleeding, shorter operation time, less trauma, resected diverticulum, increase the thickness of the lower uterine segment, shorten the duration of the contraception time, but the decrease of serum β-HCG was slow and the recovery time of menstruation was long.