不同微创手术对Ⅱ型剖宫产瘢痕妊娠的治疗效果分析
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摘要
目的探讨宫腔镜及宫腹腔镜联合手术对于Ⅱ型剖宫产瘢痕妊娠的临床治疗效果。方法收集中国医科大学附属盛京医院2013年2月至2016年1月确诊剖宫产瘢痕妊娠患者的临床资料,其中Ⅱ型患者共计58例,分为A组(行宫腔镜剖宫产瘢痕妊娠病灶切除术,n=36)和B组(行宫腹腔镜联合剖宫产瘢痕妊娠病灶切除术+子宫修补术,n=22)。比较2组患者手术情况、单次微创手术成功率、术后恢复情况以及再次妊娠结局。结果 A组手术时间[(26.6±4.9) min]明显短于B组[(63.2±8.3) min];A组出血量[(71.9±9.7) mL]明显低于B组[(80.3±8.2) mL];2组均无手术并发症发生;A组单次微创手术成功率(83.3%)与B组(86.4%)比较,无统计学差异;在月经恢复及术后血人绒毛膜促性腺激素(HCG)下降至正常范围时间方面,2组比较无统计学差异。结论宫腔镜及宫腹腔镜联合手术对于Ⅱ型剖宫产瘢痕妊娠均具有很好的治疗效果。
Objective To discuss the clinical effects of hysteroscopy and hysteroscopy combined with laparoscopy on typeⅡcesarean scar pregnancy(CSP). Methods We selected 58 patients diagnosed as having typeⅡCSP in Shengjing Hospital,China Medical University,between February 2013 and January 2016. Group A consisted of 36 patients who were treated with hysteroscopic CSP resection,while group B consisted of 22 patients treated with hysteroscopy combined with laparoscopic CSP resection and uterine repair. We compared the operation condition,single-operation success rate,postoperative recovery,and succeeding pregnancy outcome. Results The operation time in group A was 26.6±4.9 min,which was obviously shorter than that in group B. The bleeding volume in group A was 71.9±9.7 mL,which was obviously less than that in group B. No operation complication occurred in the two groups. The single-operation success rate was83.3% in group A and 86.4% in group B,indicating no significant difference. No significant differences in menstruation recovery and the rate of decrease in human chorionic gonadotropin level to normal were found between groups A and B. Conclusion Both hysteroscopy and hysteroscopy combined with laparoscopy can be used to treat typeⅡcesarean scar pregnancy.
Objective To discuss the clinical effects of hysteroscopy and hysteroscopy combined with laparoscopy on typeⅡcesarean scar pregnancy(CSP). Methods We selected 58 patients diagnosed as having typeⅡCSP in Shengjing Hospital,China Medical University,between February 2013 and January 2016. Group A consisted of 36 patients who were treated with hysteroscopic CSP resection,while group B consisted of 22 patients treated with hysteroscopy combined with laparoscopic CSP resection and uterine repair. We compared the operation condition,single-operation success rate,postoperative recovery,and succeeding pregnancy outcome. Results The operation time in group A was 26.6±4.9 min,which was obviously shorter than that in group B. The bleeding volume in group A was 71.9±9.7 mL,which was obviously less than that in group B. No operation complication occurred in the two groups. The single-operation success rate was83.3% in group A and 86.4% in group B,indicating no significant difference. No significant differences in menstruation recovery and the rate of decrease in human chorionic gonadotropin level to normal were found between groups A and B. Conclusion Both hysteroscopy and hysteroscopy combined with laparoscopy can be used to treat typeⅡcesarean scar pregnancy.
引文
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[7]苏冠男,王武亮,袁博,等.子宫切口瘢痕憩室形成的相关因素研究[J].中国全科医学,2015,18(4):421-424.DOI:10.3969/j.issn.1007-9572.2015.04.016.
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[13]DE VAATE AJ,BROLMANN HA,VANDER SLIKKE JW,et al.Therapeutic options of caesarean scar pregnancy:case series and literature review[J].J Clin Ultrasound,2010,38(2):75-84.DOI:10.1002/jcu.20648.
[14]张青,姜丽,曹云桂.剖宫产瘢痕妊娠的术式选择[J].中国微创外科杂志,2015,15(11):1025-1027.DOI:10.3969/j.issn.1009-6604.2015.11.019.
[15]FENG Y,CHEN S,LI C,et al.Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy[J].Exp Ther Med,2016,12(3):1469-1475.DOI:10.3892/etm.2016.3489.
[16]中华医学会妇产科学分会计划生育学组.剖宫产术后子宫瘢痕诊治专家共识[J].全科医学临床与教育,2017,15(1):5-9.DOI:10.3760/cma.j.issn.0529-567x.2016.08.003.
[17]鲁海燕,张文华,单君,等.经阴道手术治疗剖宫产术后子宫瘢痕妊娠31例临床分析[J].中华妇产科杂志,2011,46(12):917-921.DOI:10.376/cma.j.issn.0529-567x.2011.12.009.
[18]李康宁,姜玉新,刘真真,等.宫腔超声造影对剖宫产瘢痕妊娠治疗后的远期随访评估[J].中国医学影像技术,2016,32(3):411-415.DOI:10.13929/j.1003-3289.2016.03.023.
[2]JURKOVI D,HILLABY K,WOELFER B,et al.First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar[J].Ultrasound Obstet Gynecol,2003,21(3):220-227.DOI:10.1002/uoq.56.
[3]COK T,KALAYCI H,OZDEMIR H,et al.Transvaginal ultrasound-guided local methotrexate administration as the first-line treatment for cesarean scar pregnancy:follow-up of 18 cases[J].J Obstet Gynaecol Res,2015,41(5):803-808.DOI:10.1111/joq.12627.
[4]中华医学会计划生育学分会.剖宫产瘢痕妊娠诊断与治疗共识[J].中华医学杂志,2012,92(25):1731-1733.DOI:10.3760/cma.j.issn.0376-2491.2012.25.002.
[5]TIMOR-TTITSCH IE,MONTEAGUDO A,CALI G,et al.Cesarean scar pregnancy and early placenta accrete share common histology[J].Ultrasound Obstet Gynecol,2014,43(4):383-395.DOI:10.1002/uoq.13282.
[6]张宁宁,杨清.早孕期剖宫产瘢痕妊娠的临床及病理特点分析[J].中国医科大学学报,2011,40(5):458-461.
[7]苏冠男,王武亮,袁博,等.子宫切口瘢痕憩室形成的相关因素研究[J].中国全科医学,2015,18(4):421-424.DOI:10.3969/j.issn.1007-9572.2015.04.016.
[8]POLAT I,EKIZ A,ACAR DK,et al.Suction curettage as first line treatment in cases with cesarean scar pregnancy:feasibility and effectiveness in early pregnancy[J].J Matern Fetal Neonatal Med,2015,8(28):1-6.DOI:10.3109/14767058.2015.1034100.
[9]PENG KW,LEI Z,XIAO TH,et al.First trimester caesarean scar ectopic pregnancy evaluation using MRI[J].Clin Radiol,2014,69(2):123-129.DOI:10.1016/j.crad.2013.07.021.
[10]HUANG Q,ZHANG M,ZHAI RY.Comparison of gadolinium-enhanced magnetic resonance imaging with ultrasound in evaluation of cesarean scar pregnancy[J].J Obstet Gynaecol Res,2014,40(7):1890-1893.DOI:10.1111/jog.12445.
[11]American College of Obstetricians and Gynecologists.ACOG practice bulletin No.94:medical management of ectopic pregnancy[J].Obstet Gynecol,2008,111(6):1479-1485.DOI:10.1097/AOG.0b013e3187d201e.
[12]ZHANG H,HUANG J,WU X,et al.Clinical classification and treatment of cesarean scar pregnancy[J].J Obstet Gynaecol Res,2017,43(4):653-661.DOI:10.1111/jog.13267.
[13]DE VAATE AJ,BROLMANN HA,VANDER SLIKKE JW,et al.Therapeutic options of caesarean scar pregnancy:case series and literature review[J].J Clin Ultrasound,2010,38(2):75-84.DOI:10.1002/jcu.20648.
[14]张青,姜丽,曹云桂.剖宫产瘢痕妊娠的术式选择[J].中国微创外科杂志,2015,15(11):1025-1027.DOI:10.3969/j.issn.1009-6604.2015.11.019.
[15]FENG Y,CHEN S,LI C,et al.Curettage after uterine artery embolization combined with methotrexate treatment for caesarean scar pregnancy[J].Exp Ther Med,2016,12(3):1469-1475.DOI:10.3892/etm.2016.3489.
[16]中华医学会妇产科学分会计划生育学组.剖宫产术后子宫瘢痕诊治专家共识[J].全科医学临床与教育,2017,15(1):5-9.DOI:10.3760/cma.j.issn.0529-567x.2016.08.003.
[17]鲁海燕,张文华,单君,等.经阴道手术治疗剖宫产术后子宫瘢痕妊娠31例临床分析[J].中华妇产科杂志,2011,46(12):917-921.DOI:10.376/cma.j.issn.0529-567x.2011.12.009.
[18]李康宁,姜玉新,刘真真,等.宫腔超声造影对剖宫产瘢痕妊娠治疗后的远期随访评估[J].中国医学影像技术,2016,32(3):411-415.DOI:10.13929/j.1003-3289.2016.03.023.