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目的 探讨宫腔镜手术治疗病灶最大径线≤2.5 cm的内生型剖宫产术后子宫瘢痕妊娠(CSP)的价值.方法 回顾性分析2000年1月至2013年1月在河南省漯河市中心医院住院治疗的CSP患者的临床资料,选择病灶最大径线≤2.5 cm的内生型CSP患者61例,按照治疗方法的不同分为宫腔镜组21例,行宫腔镜手术；药物+清宫组23例,给予甲氨蝶呤+清宫术；栓塞+清宫组17例,行双侧子宫动脉栓塞+清宫术.比较3组患者的术中出血量、手术时间、治疗后住院时间、血清β-hCG转为正常的时间.结果 宫腔镜组出血量、治疗后住院时间、血清β-hCG转为正常的时间分别为(49.8±6.2)ml、(3.5±0.8)d、(21.2±2.4)d,药物+清宫组分别为(87.0±30.5) ml、(12.5±1.0)d、(29.6±2.2)d,两组各项指标分别比较,差异均有统计学意义(P＜0.05)；宫腔镜组手术时间为(33 ±4) min,药物+清宫组为(35±6)min,两组比较,差异无统计学意义(P＞0.05).宫腔镜组治疗后住院时间短于栓塞+清宫组的(4.5±0.6)d,两组比较,差异也有统计学意义(P＜0.05),宫腔镜组与栓塞+清宫组的手术时间[分别为(33 ±4)、(31 ±4) min]、术中出血量[分别为(49.8±6.2)、(46.2 ±2.8)ml]、血清β-hCG转为正常的时间[(21.2±2.4)、(23.1±2.6)d]比较,差异均无统计学意义(P＞0.05).结论 宫腔镜手术治疗病灶最大径线≤2.5 cm的内生型CSP有效、住院时间短、恢复快,值得推广.

Objective Study the effect of hysteroscopic surgery in treatment of small mass of caesarean scar pregnancy(CSP).Methods From January 2000 to January 2013,61 cases lesions ≤2.5 cm diameter of endogenous CSP undergoing treatment in Luohe Central Hospital were studied retrospectively.According to different treatment,they were divided into 21 cases in hysteroscopic surgery group,23 cases in methotrexate + operation group and 17 cases in bilateral uterine artery embolism + curettage group.Intraoperative blood loss,operative time,hospitalization time after treatment and β-hCG to normal time were compared among those three groups.Results The surgical blood loss,hospitalization time after treatment,β-hCG to normal time were (49.8 ± 6.2) ml,(3.5 ± 0.8) days,(21.2 ± 2.4) days in hysteroscopic group,(87.0 ±30.5) ml,(12.5 ± 1.0) days,(29.6 ±2.2) days in methotrexate + operation group,the difference was statistically significant (P ＜ 0.05).The operation time were (33 ± 4) minutes in hysteroscopic surgery group and (35 ± 6) minutes in methotrexate + operation group,which did not reached significant difference (P ＞ 0.05).Length of hospital stay after treatment of hysteroscopic surgery group is less than the bilateral uterine artery embolism + curettage group significantly (P ＜ 0.05).Operation time,surgical bleeding and β-hCG to normal time had no obvious difference between hysteroscopic surgery and in bilateral uterine artery embolism + curettage group (P ＞ 0.05).Conclusion Hysteroscopy surgery in treatment of small mass endogenous CSP is effective,shorter hospitalization time,quick recovery.