Management of persistent caesarean scar pregnancy after curettage treatment failure.
Management of persistent caesarean scar pregnancy after curettage treatment failure.
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DOI：
10.1186/s12884-017-1395-4
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发表时间：
2017-07-01
影响因子：
3.1
通讯作者：
Huang LL
中科院分区：
文献类型：
--
作者：
Qian ZD;Weng Y;Du YJ;Wang CF;Huang LL
剖宫产瘢痕妊娠（CSP）是剖宫产术后的一种晚期严重并发症。近年来，CSP的发病率在世界范围内呈上升趋势。早期诊断和及时治疗对于避免灾难性并发症至关重要。治疗CSP有多种策略，但对CSP的最佳管理尚无共识。扩张术和宫腔镜是常见而有效的治疗方法，各有优缺点。D&C治疗失败后宫腔镜治疗CSP的临床效果尚未深入研究。本研究的目的是评估宫腔镜下切除残余CSP组织（持续性CSP）作为D&C治疗失败后的抢救的有效性和安全性。这是一项回顾性临床研究。45例剖宫产术失败后行手术宫腔镜切除瘢痕内残留妊娠组织。对45例CSP的临床特点及宫腔镜手术效果进行分析。所有数据分析均采用SPSS 17.0软件进行。43例CSP刮除失败后经手术宫腔镜治疗成功。估计术中出血量20.00 (10.00-500.00)mL，宫腔镜手术时间20.00 (15.00-45.00)min，术后第1天血清β-hCG下降71.91±14.05%，总住院时间7.87±2.26 d，医疗费用13682.71±3553.77元，术后出血时间7.42±2.48 d，术后血清β-hCG消退时间13.84±9.83 d。出院后随访，无严重并发症。宫腔镜治疗可有效、安全地治疗刮除失败后的持续性CSP。治疗应个体化，宫腔镜手术和麻醉的风险和费用必须在手术前与患者充分讨论。
Caesarean scar pregnancy (CSP) is a late serious complication of caesarean section. The incidence of CSP has increased worldwide in recent years. Early diagnosis and prompt therapy are crucial to avoid catastrophic complications. There are various strategies for CSP treatment, but there is no consensus on the best management for CSP. Dilation and curettage (D&C) and hysteroscopy are common and effective treatments with their advantages and disadvantages. No in-depth study of the clinical effects of hysteroscopic management of CSP after D&C treatment failure has been conducted. The purpose of this study is to evaluate the effectiveness and safety of hysteroscopic removal of residual CSP tissue (persistent CSP) as a rescue after failed D&C management. This is a retrospective clinical research study. Forty-five patients underwent operative hysteroscopy to remove the residual gestational tissue in the caesarean scar after failed D&C treatment. The clinical characteristics and outcomes of hysteroscopic surgeries of 45 CSP cases were investigated. All data analyses were conducted with SPSS 17.0. Forty-three CSP cases after unsuccessful curettage treatment were successfully treated by operative hysteroscopy. The estimated intraoperative blood loss was 20.00 (10.00–500.00) mL, the hysteroscopic operating time was 20.00 (15.00–45.00) min, the decline of serum β-hCG the day after surgery was 71.91 ± 14.05%, the total hospitalisation time was 7.87 ± 2.26 days, the medical cost was 13,682.71 ± 3553.77 China Yuan (CNY), the time of bleeding after surgery was 7.42 ± 2.48 days, and the time of serum β-hCG resolution after surgery was 13.84 ± 9.83 days. Follow-up after discharge demonstrated that there were no severe complications for any patients. Hysteroscopy therapy could treat persistent CSP effectively and safely after curettage treatment failure. Therapy should be individualised, and the risks and cost of the hysteroscopy procedure and anaesthesia must be considered and fully discussed with the patients before surgery.