宫腔镜刨削术治疗剖宫产瘢痕妊娠的临床疗效与生育力保护研究

Clinical efficacy and fertility preservation of hysteroscopic morcellation in the treatment of cesarean scar pregnancy

摘要:

目的 对比宫腔镜刨削术与超声引导下清宫术治疗剖宫产瘢痕妊娠（CSP）的临床效果，评估两种术式对患者生育力的影响。方法 采用前瞻性队列研究，纳入2022年10月－2025年12月该院收治的Ⅰ型及Ⅱ型CSP患者120例，分为研究组（采用宫腔镜刨削术，n = 60）和对照组（采用超声引导下清宫术，n = 60）。比较两组围手术期指标、并发症、术后恢复及远期生育结局。结果 研究组术中出血量少于对照组，一次性完整切除率高于对照组，术后炎症指标水平和术中大出血发生率低于对照组，差异均有统计学意义（P < 0.01）。研究组术后血人绒毛膜促性腺激素（hCG）下降更快，月经复潮更早，但术后住院时间较对照组长（P < 0.01）。术后3个月，研究组子宫内膜厚度及瘢痕处残余肌层最薄厚度大于对照组，宫腔粘连发生率低于对照组，差异均有统计学意义（P < 0.01）。术后12个月内，有再生育意愿的患者中，研究组自然妊娠率明显高于对照组，差异有统计学意义（P < 0.05）。结论 宫腔镜刨削术治疗CSP具有精准、出血少、创伤轻、一次性成功率高及并发症少的优势，但住院时间较长。其微创特性有效地保护了子宫内膜与瘢痕结构，促进了生殖功能的恢复，明显改善了患者的生育预后，是CSP患者生育力保护的优选术式。

Abstract:

Objective To compare and analyze the clinical efficacy of hysteroscopic morcellation and ultrasound-guided evacuation of the uterus in the treatment of cesarean scar pregnancy (CSP), with a focus on evaluating the effects of the two surgical approaches on patients’ fertility.Methods A prospective cohort study was conducted, enrolling 120 patients with type Ⅰ and type Ⅱ CSP admitted from October 2022 to December 2025. The patients were divided into the study group (hysteroscopic morcellation, n = 60) and the control group (ultrasound-guided evacuation of the uterus, n = 60). Perioperative indicators, complications, postoperative recovery and long-term reproductive outcomes were compared between the two groups.Results The intraoperative blood loss in the study group was less compared with the control group, the one-time clearance rate in the study group was higher compared with the control group, postoperative levels of inflammatory markers and the incidence of severe hemorrhage in the study group were lower compared with the control group, and the differences were statistically significant (P < 0.01). The study group had a faster decline in postoperative serum human chorionic gonadotropin (hCG) and an earlier resumption of menstruation compared with the control group, whereas its postoperative hospital stay was longer than that of the control group, the differences were statistically significant (P < 0.01). At 3 months after surgery, the study group achieved better recovery in endometrial thickness and minimum thickness of residual myometrium at the cesarean scar, with a lower incidence of intrauterine adhesion compared with the control group, the differences were statistically significant (P < 0.01). Within 12 months after surgery, the natural pregnancy rate of patients with fertility intentions in the study group was significantly higher than that in the control group, and the difference was statistically significant (P < 0.05).Conclusion Hysteroscopic morcellation for CSP has the advantages of high precision, less bleeding, mild trauma, a high one-time success rate and few complications, albeit with a longer hospital stay. Its minimally invasive properties effectively protect the endometrial and scar structures, promote the recovery of reproductive function, and significantly improve the reproductive prognosis of patients, making it the preferred surgical method for fertility preservation in patients with CSP.