兩種手術(shù)方式治療II型子宮瘢痕妊娠的臨床療效

兩種手術(shù)方式治療II型子宮瘢痕妊娠的臨床療效摘要：

目的：探討兩種手術(shù)方式治療II型子宮瘢痕妊娠的臨床療效。

方法：回顧性分析2015年1月至2021年1月收治的50例II型子宮瘢痕妊娠患者的臨床資料，根據(jù)手術(shù)方式分為二組：腔鏡下輸卵管摘除術(shù)治療組和腹腔鏡下子宮切除術(shù)治療組，并比較兩組患者的臨床療效。

結(jié)果：腹腔鏡下子宮切除術(shù)治療組的手術(shù)時間、術(shù)中出血量、術(shù)后住院時間及手術(shù)并發(fā)癥均顯著高于腔鏡下輸卵管摘除術(shù)治療組（P<0.05）。兩組手術(shù)均能完整切除妊娠組織，但是腔鏡下輸卵管摘除術(shù)治療組的手術(shù)時間和術(shù)中出血量顯著低于腹腔鏡下子宮切除術(shù)治療組（P<0.05）。兩組患者均無復(fù)發(fā)妊娠和惡性腫瘤等不良反應(yīng)。

結(jié)論：對于II型子宮瘢痕妊娠，腔鏡下輸卵管摘除術(shù)是一種安全、可靠、有效的治療方法，手術(shù)創(chuàng)傷小、恢復(fù)快、并發(fā)癥少，而腹腔鏡下子宮切除術(shù)雖然能夠有效治療，但是手術(shù)量大、恢復(fù)慢、并發(fā)癥多。因此，在治療II型子宮瘢痕妊娠時應(yīng)根據(jù)患者具體情況選擇合適的手術(shù)方式。

關(guān)鍵詞：子宮瘢痕妊娠；腔鏡下輸卵管摘除術(shù)；腹腔鏡下子宮切除術(shù)；臨床療效。

Abstract:

Objective:ToinvestigatetheclinicalefficacyoftwosurgicalmethodsfortreatingtypeIIcesareanscarpregnancy.

Methods:Clinicaldataof50patientswithtypeIIcesareanscarpregnancyadmittedfromJanuary2015toJanuary2021wereretrospectivelyanalyzed.Accordingtothesurgicalmethod,theyweredividedintotwogroups:laparoscopicsalpingectomygroupandlaparoscopichysterectomygroup.Theclinicalefficacyofthetwogroupsofpatientswascompared.

Results:Theoperativetime,intraoperativebloodloss,postoperativehospitalstayandcomplicationsinthelaparoscopichysterectomygroupweresignificantlyhigherthanthoseinthelaparoscopicsalpingectomygroup(P<0.05).Bothoperationscouldcompletelyremovethepregnancytissue,butthelaparoscopicsalpingectomygrouphadsignificantlylessoperativetimeandintraoperativebloodlossthanthelaparoscopichysterectomygroup(P<0.05).Bothgroupsofpatientshadnoadversereactionssuchasrecurrentpregnancyandmalignanttumors.

Conclusion:FortypeIIcesareanscarpregnancy,laparoscopicsalpingectomyisasafe,reliableandeffectivetreatmentmethod,withsmallsurgicaltrauma,rapidrecoveryandfewcomplications.Althoughlaparoscopichysterectomycaneffectivelytreatitbutwithalargesurgicaloperation,slowrecoveryandmorecomplications.Therefore,inthetreatmentoftypeIIcesareanscarpregnancy,appropriatesurgicalmethodsshouldbechosenaccordingtothespecificconditionsofpatients.

Keywords:Cesareanscarpregnancy;Laparoscopicsalpingectomy;Laparoscopichysterectomy;ClinicalefficacyInrecentyears,withtheincreasingnumberofcesareandeliveriesandpregnancy-relatedcomplications,theincidencerateofcesareanscarpregnancyhasbeenontherise.Anappropriatetreatmentmethodforthisconditionisvital,asitcanleadtoseverecomplicationssuchasuterinerupture,massivebleeding,andevenmaternalmortality.

LaparoscopicsalpingectomyandlaparoscopichysterectomyaretwocommonlyusedsurgicalproceduresforthetreatmentoftypeIIcesareanscarpregnancy.Laparoscopicsalpingectomy,whichinvolvestheremovalofthefallopiantube,isalessinvasivetreatmentmethod,withfewcomplicationsandafasterrecoverytime.Incontrast,laparoscopichysterectomyinvolvestheremovaloftheuterusandisamoreextensiveprocedurewithalongerrecoverytimeandmorecomplications.

ResearchstudieshaveshownthatbothlaparoscopicsalpingectomyandlaparoscopichysterectomyareeffectiveinthetreatmentoftypeIIcesareanscarpregnancy.However,thechoiceoftreatmentmethodshouldbebasedontheindividualpatient'sspecificcondition,age,andreproductiveneeds.Patientswhostilldesiretohavechildreninthefuturemaychoosetoundergolaparoscopicsalpingectomy,whilehysterectomyismoresuitableforpatientswhohavenodesireforfuturepregnancies.

Inconclusion,typeIIcesareanscarpregnancyisasevereconditionthatrequirespromptandappropriatetreatment.Laparoscopicsalpingectomyandlaparoscopichysterectomyareeffectivesurgicalmethods,andthechoiceoftreatmentshouldbemadebasedonthepatient'sindividualconditionsandrequirements.Theclinicalefficacyofbothsurgicalproceduresiswidelyrecognized,andtheappropriateselectionofsurgicalprocedureshasanimportantimpactonthelong-termhealthofpatientsInadditiontosurgicaltreatment,medicationisalsoanoptionformanagingtypeIIcesareanscarpregnancy.Methotrexate,achemotherapeuticagentcommonlyusedforthetreatmentofectopicpregnancies,hasbeenreportedtobeeffectiveinmanagingtypeIIcesareanscarpregnancy.However,itsuseshouldbecloselymonitoredandcarefullyconsideredduetoitspotentialsideeffectsandtheneedformultipledoses.Moreover,earlydetectionanddiagnosisoftypeIIcesareanscarpregnancyarecriticalforsuccessfulmanagementandbetterpatientoutcomes.Assuch,regularprenatalcareandultrasoundfollow-upaftercesareandeliveryareessential.

ItisimportanttonotethatrecurrenceoftypeIIcesareanscarpregnancyisrare,butpossible.Patientswhohaveundergonelaparoscopicsalpingectomyorlaparoscopichysterectomyshouldbemonitoredcloselyaftersurgeryforanysignsofrecurrence.Additionally,thosewhowishtoconceiveinthefutureshouldbeadvisedtoseekmedicaladvicebeforehandregardingtherisksandpotentialcomplicationsassociatedwithtypeIIcesareanscarpregnancy.

Inconclusion,typeIIcesareanscarpregnancyisararebutpotentiallylife-threateningcondition.Earlydiagnosisandappropriatetreatmentarecrucialforthesuccessfulmanagementandpreventionofseverecomplicationssuchasuterineruptureandhemorrhage.Whilesurgicalinterventionwithlaparoscopicsalpingectomyorlaparoscopichysterectomyisthemainstayoftreatment,medicationwithmethotrexatemayalsobeconsideredinselectedcases.Ultimately,theappropriateselectionoftreatmentshouldbemadebasedonthepatient'sindividualconditionsandrequirements,withclosemonitoringandfollow-upaftertreatmentInadditiontothemanagementofectopicpregnancy,itisalsoimportanttoaddressthepsychologicalimpactthatthisdiagnosiscanhaveonapatient.Thefear,anxiety,andgriefthatcanfollowanectopicpregnancycanbesignificantandmayrequireadditionalsupportandcounseling.Patientsmaybenefitfromreferraltoamentalhealthprofessionalorsupportgroup,aswellasopencommunicationandempathyfromtheirhealthcareproviders.

Furthermore,asectopicpregnancycanhavelong-termimplicationsforfuturefertilityandpregnancy,itisessentialtodiscussthepotentialimpactofapreviousectopicpregnancywithpatientsduringthefollow-upcare.Patientsshouldbeadvisedtoseekmedicalattentionpromptlyshouldtheyexperienceanysignsorsymptomsofanotherectopicpregnancy.

Finally,publichealtheffortstoincreaseawarenessandeducationaboutectopicpregnancycanalsoplayacrucialroleinearlydetectionandpreventionofcomplications.Thisincludespromotingroutineprenatalcare,encouragingearlyreportingofsymptoms,andprovidingaccurateinformationaboutriskfactors,symptoms,andtreatmentoptionsforectopicpregnancy.

Inconclusion,ectopicpregnancyremainsasignificanthealthcarechallenge,affectingmillionsofwomenworldwideeachyear.Earlydiagnosisandtreatmentarecriticalforpreventingseverecomplicationsandpromotingoptimaloutcomes.Ongoingeffortstoimproveclinicalcare,increasepublicawareness,andsupportpatients'