摘要
目的探讨不同方法治疗剖宫产术后子宫瘢痕妊娠(cesarean scar pregnancy,CSP)的临床效果和预后。方法回顾性分析本院2013年1月至2018年5月收治的153例CSP患者的临床资料,按不同治疗方法分为4组,分别采用超声引导下清宫手术(15例)、子宫动脉栓塞术(uterine arterial embolization,UAE)联合甲氨蝶呤(methotrexate,MTX)后超声引导下清宫术(104例)、UAE联合MTX后腹腔镜监控下清宫术(12例)和开腹子宫瘢痕妊娠物清除术(22例)。比较各组治疗前后的临床表现和预后特点。结果所有患者均治愈,无子宫切除。4组患者的年龄、停经天数、妊娠次数、生产次数、人流次数、距离上次剖宫产时间、剖宫产次数、胎囊最大径、术后48小时黄体酮下降幅度及住院时间比较差异无显著性(P>0.05),而瘢痕肌层厚度、术前血清β-人绒毛膜促性腺激素(human chorionic gonadotrophin,β-hCG)水平、术前黄体酮水平、CSP分型差异有显著性(P<0.05);4组患者的术中出血量、术后48小时β-hCG下降幅度、手术时间、住院花费比较差异有显著性(P<0.05),而住院时间比较差异无显著性(P>0.05)。结论超声引导下清宫术操作简单、损伤小、费用低。腹腔镜和开腹手术更适合外源性CSP患者,可降低手术风险,防止子宫穿孔,但腹腔镜手术要比其他3种手术费用更高,而开腹手术操作时间长、出血量大、住院时间长。CSP应根据患者不同情况制订个性化治疗方案。
Objective To investigate the clinical manifestations and prognostic features of different treatments for uterine scar pregnancy（CSP） after cesarean section. Method We retrospectively analyzed 153 cases of CSP that were treated in our hospital. They were divided into 4 groups according to different treatment methods. 15 cases received curettage under ultrasonography, ultrasonic curettage after UAE combined with MTX in 104 cases, 12 cases of UAE combined with MTX under retroperitoneal laparoscopy for curettage,22 patients underwent uterine scar pregnancy removal. The clinical manifestations and prognostic characteristics of each group before and after treatment were compared. Result All 153 patients were cured without hysterectomy. There were no significant differences among the 4 groups in age, menopausal days, pregnancy times, times of labor, times of abortion, distance from the last cesarean section, times of cesarean section, maximum diameter of fetal sac, proportion of progesterone decrease 48 hours after operation and hospitalization time（P〈0.05）. But there were significant differences in scar myometrial thickness, preoperative β-hCG level, preoperative progesterone level and CSP typing（P〉0.05）. There were significant differences between the 4 groups in the amount of bleeding during operation, the decrease ofβ-hCG 48 hours after operation, the operation time and the hospitalization cost（P〈0.05）, but there was no significant difference in the hospitalization time（P〉0.05）. Conclusion Ultrasound uterine surgery is simple, less invasive and low in cost. Laparoscopic and open surgery are more suitable for patients with exogenous CSP, reducing the risk of surgery and preventing uterine perforation. However, laparoscopic surgery costs more than the other 3 procedures, while open surgery results in long operation time, large amount of bleeding and long hospital stay. The CSP treatment plan should be personalized according to different situations.
作者
张小围
杨悦
ZHANG Xiao-wei;YANG Yue(Department of Obstetrics and Gynecology,Civil Aviation General Hospital,Beijing 100123,China)
出处
《中国医刊》
CAS
2018年第11期1257-1261,共5页
Chinese Journal of Medicine
基金
首都医学发展科研基金(首发2016-1-4091)
