聚桂醇联合清宫术对剖宫产子宫瘢痕妊娠的疗效
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摘要
目的探讨聚桂醇联合清宫术对子宫瘢痕妊娠的疗效。方法回顾性分析浙江省台州医院2014年6月至2017年5月收治的146例剖宫产术后瘢痕妊娠患者的临床资料,其中68例在子宫动脉栓塞术后48~72小时行清宫术,作为对照组;78例经阴道超声引导穿刺聚桂醇注射后4~20小时行清宫术,作为观察组,比较两组临床治疗效果。结果治疗后观察组有效率为91.03%(71/78),对照组有效率为86.76%(59/68),两组比较无显著差异(χ2=0.676,P=0.411)。两组患者出血量比较无显著差异(t=0.115,P>0.05),但观察组病灶吸收时间、血人绒毛膜促性腺激素(β-hCG)恢复正常时间、住院时间均明显短于对照组,治疗费用明显少于对照组(t值分别为14.640、10.052、13.103、18.187,均P<0.05)。观察组术后不良反应总发生率为6.41%,显著低于对照组的22.06%(χ2=7.525,P<0.05)。结论经阴道超声引导穿刺聚桂醇注射联合清宫术在子宫瘢痕妊娠患者中的应用效果显著,具有创伤小、恢复快、住院时间短、并发症少、费用低等优点,适用于基层医院,值得应用推广。
Objective To study the effect of lauromacrogol combined with curettage on uterine scar pregnancy.Methods Retrospective analysis was carried out on the clinical data of 146 patients with uterine scar pregnancy after cesarean section who received therapy from June 2014 to May 2017 in Zhejiang Taizhou Hospital,including 68 cases undergoing curettage at 48-72 hours after uterine artery embolization in control group and 78 cases undergoing curettage at 4-20 hours after transvaginal ultrasoundguided percutaneous injection of lauromacrogol in observation group.The clinical therapeutic effects of two groups were compared.Results After treatment,the effective rate of the observation group was 91.03%(71/78),and that of the control group was86.76%(59/68).There was no significant difference between two groups(χ2=0.676,P=0.411).The difference in the amount of bleeding was not significant between two groups(t=0.115,P >0.05),but the time of lesion absorption,human chorionic gonadotropin(β-HCG)recovery time and hospitalization time were significantly shorter in the observation group than in the control group,and the cost of treatment was significantly less than that of the control group(t value was 14.640,10.052,13.103 and18.187,respectively,all P <0.05).The total incidence of adverse reactions in the observation group was 6.41%,which was significantly lower than 22.06% in the control group(χ2=7.525,P <0.05).Conclusion Transvaginal ultrasound-guided percutaneous injection of lauromacrogol combined with curettage is good for uterine scar pregnancy,and it has the advantages of mild trauma,quick recovery,short hospitalization time,few complications and low cost.It's worthy of application and promotion.
Objective To study the effect of lauromacrogol combined with curettage on uterine scar pregnancy.Methods Retrospective analysis was carried out on the clinical data of 146 patients with uterine scar pregnancy after cesarean section who received therapy from June 2014 to May 2017 in Zhejiang Taizhou Hospital,including 68 cases undergoing curettage at 48-72 hours after uterine artery embolization in control group and 78 cases undergoing curettage at 4-20 hours after transvaginal ultrasoundguided percutaneous injection of lauromacrogol in observation group.The clinical therapeutic effects of two groups were compared.Results After treatment,the effective rate of the observation group was 91.03%(71/78),and that of the control group was86.76%(59/68).There was no significant difference between two groups(χ2=0.676,P=0.411).The difference in the amount of bleeding was not significant between two groups(t=0.115,P >0.05),but the time of lesion absorption,human chorionic gonadotropin(β-HCG)recovery time and hospitalization time were significantly shorter in the observation group than in the control group,and the cost of treatment was significantly less than that of the control group(t value was 14.640,10.052,13.103 and18.187,respectively,all P <0.05).The total incidence of adverse reactions in the observation group was 6.41%,which was significantly lower than 22.06% in the control group(χ2=7.525,P <0.05).Conclusion Transvaginal ultrasound-guided percutaneous injection of lauromacrogol combined with curettage is good for uterine scar pregnancy,and it has the advantages of mild trauma,quick recovery,short hospitalization time,few complications and low cost.It's worthy of application and promotion.
引文
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[11]Kitagawa A,Yamamoto T,Matsunaga N,et al.Polidocanol sclerotherapy combined with transarterial embolization using n-Butyl cyanoacrylate for extracranial arteriovenous malformations[J].Cardiovasc Intervent Radiol,2018,41(6):856-866.
[12]Gatz M,Schrading S,Dirrichs T,et al.Topical polidocanol application in combination with static stretching in tendinopathies:aprospective pilot study[J].Muscles Ligaments Tendons J,2017,10;7(1):88-97.
[13]戚云峰,董晓秋,张立维,等.超声引导下聚桂醇辅助射频消融术治疗子宫肌瘤的临床价值[J].中国超声医学杂志,2016,32(11):1022-1024.
[14]Kurnicki J,Oska M,Tworus R,et al.Ultrasoundguided foam sclerotherapy of great saphenous vein with2%polidocanol-one-year follow-up results[J].Wideochir Inne Tech Maloinwazyjne,2016,11(2):67-75.
[15]张淑珍,赵玲利,李明奎,等.超声介入下注射聚桂醇在治疗剖宫产瘢痕妊娠61例中的应用[J].实用妇产科杂志,2015,31(02):112-115.
[2]Washburn E E,Pocius K,Carusi D.Outcomes of nonsurgical versus surgical treatment of cesarean scar pregnancies in the first trimester[J].Arch Gynecol Obstet,2017,296(3):533-541.
[3]Yamaki T,Sasaki Y,Hasegawa Y,et al.Percutaneous ultrasound-guided sclerotherapy with polidocanol microfoam for lymphatic malformations[J].J Vasc Surg Venous Lymphat Disord,2017,5(5):707-714.
[4]宋于生,田云飞,赖卫国,等.经皮注射聚桂醇泡沫硬化剂在乏血供肝血管瘤的应用[J].实用医学杂志,2016,32(24):4094-4097.
[5]顾美皎.临床妇产科学[M].北京.人民卫生出版社,2001:17-20.
[6]Dagdeviren E G,Dur R,Fadloglu E,et al.Molar pregnancy in cesarean section scar:A case report[J].Turk J Obstet Gynecol,2017,14(4):249-225.
[7]顾逢春,凌静,朱玉莲,等.150例高龄疤痕子宫孕产妇妊娠结局分析[J].中国妇幼健康研究,2017,28(09):1143-1146.
[8]Setubal A,Alves J,Osório F,et al.Treatment for uterine isthmocele,apouchlike defect at the site of a cesarean section scar[J].J Minim Invasive Gynecol,2018,25(1):38-46.
[9]CalìG,Timor-Tritsch I E,Palacios-Jaraquemada J,et al.Outcome of cesarean scar pregnancy managed expectantly:systematic review and meta-analysis[J].Ultrasound Obstet Gynecol,2018,51(2):169-175.
[10]Hooker A,Fraenk D,Br9lmann H,et al.Prevalence of intrauterine adhesions after termination of pregnancy:a systematic review[J].Eur J Contracept Reprod Health Care,2016,21(4):329-335.
[11]Kitagawa A,Yamamoto T,Matsunaga N,et al.Polidocanol sclerotherapy combined with transarterial embolization using n-Butyl cyanoacrylate for extracranial arteriovenous malformations[J].Cardiovasc Intervent Radiol,2018,41(6):856-866.
[12]Gatz M,Schrading S,Dirrichs T,et al.Topical polidocanol application in combination with static stretching in tendinopathies:aprospective pilot study[J].Muscles Ligaments Tendons J,2017,10;7(1):88-97.
[13]戚云峰,董晓秋,张立维,等.超声引导下聚桂醇辅助射频消融术治疗子宫肌瘤的临床价值[J].中国超声医学杂志,2016,32(11):1022-1024.
[14]Kurnicki J,Oska M,Tworus R,et al.Ultrasoundguided foam sclerotherapy of great saphenous vein with2%polidocanol-one-year follow-up results[J].Wideochir Inne Tech Maloinwazyjne,2016,11(2):67-75.
[15]张淑珍,赵玲利,李明奎,等.超声介入下注射聚桂醇在治疗剖宫产瘢痕妊娠61例中的应用[J].实用妇产科杂志,2015,31(02):112-115.