米非司酮及米索前列醇联合宫腔镜切除内生型子宫下段剖宫产切口瘢痕处妊娠的疗效
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摘要
目的探讨米非司酮及米索前列醇联合宫腔镜切除内生型子宫下段剖宫产切口瘢痕处妊娠的临床效果。方法应用回顾性研究方法对本院2015年1月至2017年10月收治的135例内生型子宫下段剖宫产切口瘢痕处妊娠患者的病例资料进行分析,根据治疗方式分为A组(米非司酮及米索前列醇联合宫腔镜)、B组(甲氨蝶呤全身用药+清宫术)、C组(子宫动脉栓塞术+清宫术)各45例,对比三种方法的治疗效果。结果手术前,A、B、C三组患者的孕囊大小、血清β-人绒毛膜促性腺激素(β-HCG)水平比较,差异均无统计学意义(P> 0. 05);手术后,A、C两组患者的手术时间、术中出血量、血清β-HCG降至正常时间、阴道出血时间、住院时间均显著低于B组(P <0. 05); A组和C组的手术时间、血清β-HCG降至正常时间、阴道出血时间、住院时间比较差异无统计学意义(P> 0. 05),A组的月经来潮时间显著短于B组和C组(P <0. 05); A、B、C三组的治疗有效率分别为100. 00%、97. 78%、100. 00%,三组间比较差异均无统计学意义(P> 0. 05); A、B、C三组的治疗并发症发生率分别为2. 22%、13. 33%、4. 44%,三组间比较差异均无统计学意义(P> 0. 05)。结论三种方法治疗内生型子宫下段剖宫产切口瘢痕处妊娠效果相当,米非司酮及米索前列醇联合宫腔镜具有手术创伤更小、术后恢复更快的特点。
Objective To investigate the clinical effect of mifepristone and misoprostol combined with hysteroscopic resection of endometrial uterine incision cesarean scar pregnancy. Methods A retrospective study was conducted to analyze 135 cases of scar pregnancy of endogenous lower uterine cesarean section from January 2015 to October 2017. According to the treatment methods,they were divided into group A( mifepristone and misoprostol combined with hysteroscopy),group B( methotrexate combined with hysteroscopy),group C( Uterine artery embolization + curettage). Each group had 45 cases,and the therapeutic effects of the three methods were compared. Results There was no significant difference in gestational sac size and serum human chorionic gonadotropin [beta-human chorionic gonadotropin( HCG) ] levels among the three groups before operation( P > 0. 05). After operation,the operation time,intraoperative bleeding volume,serum beta-HCG dropping to normal time,vaginal bleeding time and hospitalization time in A and C group were significantly lower than that in B group( P > 0. 05). There was no significant difference between group A and group C in operation time,serum beta-HCG to normal time,vaginal bleeding time and hospitalization time( P > 0. 05). The menstruation time of group A was significantly shorter than that of group B and group C( P < 0. 05). The effective rates of group A,B and C were 100. 00%,97. 78%and 100. 00% respectively,with no significant difference in the three groups( P > 0. 05); The complication rates of A,B and C groups were 2. 22%,13. 33% and 4. 44% respectively,with no significant difference in the three groups( P > 0. 05). Conclusions The three methods are effective in the treatment of cesarean scar pregnancy. The mifepristone and misoprostol combined with hysteroscopy have the advantages of less operative trauma and faster postoperative recovery.
Objective To investigate the clinical effect of mifepristone and misoprostol combined with hysteroscopic resection of endometrial uterine incision cesarean scar pregnancy. Methods A retrospective study was conducted to analyze 135 cases of scar pregnancy of endogenous lower uterine cesarean section from January 2015 to October 2017. According to the treatment methods,they were divided into group A( mifepristone and misoprostol combined with hysteroscopy),group B( methotrexate combined with hysteroscopy),group C( Uterine artery embolization + curettage). Each group had 45 cases,and the therapeutic effects of the three methods were compared. Results There was no significant difference in gestational sac size and serum human chorionic gonadotropin [beta-human chorionic gonadotropin( HCG) ] levels among the three groups before operation( P > 0. 05). After operation,the operation time,intraoperative bleeding volume,serum beta-HCG dropping to normal time,vaginal bleeding time and hospitalization time in A and C group were significantly lower than that in B group( P > 0. 05). There was no significant difference between group A and group C in operation time,serum beta-HCG to normal time,vaginal bleeding time and hospitalization time( P > 0. 05). The menstruation time of group A was significantly shorter than that of group B and group C( P < 0. 05). The effective rates of group A,B and C were 100. 00%,97. 78%and 100. 00% respectively,with no significant difference in the three groups( P > 0. 05); The complication rates of A,B and C groups were 2. 22%,13. 33% and 4. 44% respectively,with no significant difference in the three groups( P > 0. 05). Conclusions The three methods are effective in the treatment of cesarean scar pregnancy. The mifepristone and misoprostol combined with hysteroscopy have the advantages of less operative trauma and faster postoperative recovery.
引文
[1] Api M,Boza A,Gorgen H,et al. Should Cesarean Scar Defect Be Treated Laparoscopically? A Case Report and Review of the Literature[J]. J Minim Invasive Gynecol,2015,22(7):1145-1152.DOI:10. 1016/j. jmig. 2015. 06. 013.
[2]宋佳玉,张清伟,赵晓,等.甲氨蝶呤不同给药方式联合宫腔镜治疗瘢痕妊娠的疗效比较[J].中国药房,2015,26(27):3774-3776. DOI:10. 6039/j. issn. 1001-0408. 2015. 27. 11.
[3]张清伟,宋佳玉,赵晓,等.超声引导下甲氨蝶呤囊内注射联合宫腔镜治疗剖宫产瘢痕妊娠的临床研究[J].中国妇产科临床杂志,2015,16(2):169-171. DOI:10. 13390/j. issn. 1672-1861. 2015. 02. 024.
[4]李晓娟,周宏伟,宋丽华,等.双侧子宫动脉栓塞联合甲氨蝶呤灌注化疗后B超引导下刮宫术在剖宫产术后瘢痕妊娠中的应用效果分析[J].中国医师杂志,2018,20(1):124-126.DOI:10. 3760/cma. j. issn. 1008-1372. 2018. 01. 034.
[5]梁翠霞,李娟,李杏婵,等.宫腔镜引导下经阴道子宫瘢痕憩室切除术27例体会[J].山东医药,2015,55(30):107. DOI:10. 3969/j. issn. 1002-266X. 2015. 30. 048.
[6] Yamaguchi M,Honda R,Uchino K,et al. Transvaginal methotrexate injection for the treatment of cesarean scar pregnancy:efficacy and subsequent fecundity[J]. J Minim Invasive Gynecol,2014,21(5):877-883. DOI:10. 1016/j. jmig. 2014. 03. 024.
[7]赵彦婷,刘彦肖,杨萍,等.药物联合宫腔镜对剖宫产术后子宫瘢痕妊娠患者生育功能影响[J].现代仪器与医疗,2016,22(2):85-87. DOI:10. 11876/mimt201602032.
[8]马艳,孙玉琴,刘羽. 31例介入合并甲氨蝶呤治疗子宫瘢痕妊娠的分析[J].安徽医科大学学报,2014,49(1):125-127.DOI:10. 19405/j. cnki. issn1000-1492. 2014. 01. 034.
[9] Kelek9i S,Aydog(mu爧S,Aydog(mu爧H,et al. Ineffectual Medical Treatment of Cesarean Scar Ectopic Pregnancy With Systemic Methotrexate:A Report of Two Cases[J]. J Investig Med High Impact Case Rep,2014,2(1):2324709614528903. DOI:10.1177/2324709614528903.
[10] Li YR,Xiao SS,Wan YJ,et al. Analysis of the efficacy of three treatment options for cesarean scar pregnancy management[J]. J Obstet Gynaecol Res,2014,40(11):2146-2151. DOI:10. 1111/jog. 12468.
[11]李长东,冯颖,陈素文,等.宫腔镜、腹腔镜治疗剖宫产瘢痕妊娠72例分析[J].中国工程科学,2014,16(5):20-23. DOI:10. 3969/j. issn. 1009-1742. 2014. 05. 004.
[12]黄华仪,罗月明,许茵.宫腔镜手术治疗内生型剖宫产瘢痕妊娠34例临床分析[J].中国微创外科杂志,2015,15(8):720-722. DOI:10. 3969/j. issn. 1009-6604. 2015. 08. 015.
[13]李娟,干晓琴,林海,等.宫腔镜下清宫术治疗剖宫产瘢痕妊娠前不同预处理方式的疗效分析[J].实用妇产科杂志,2016,32(9):705-708.
[14]范佳颖,谢静颖,卢燕玲,等.宫腔镜联合清宫术治疗内生型剖宫产瘢痕妊娠32例临床分析[J].中国实用妇科与产科杂志,2016,32(7):693-696.
[15] Boza A,Boza B,Api M. Cesarean Scar Pregnancy Managed with Conservative Treatment[J]. Iran J Med Sci,2016,41(5):450-455.
[2]宋佳玉,张清伟,赵晓,等.甲氨蝶呤不同给药方式联合宫腔镜治疗瘢痕妊娠的疗效比较[J].中国药房,2015,26(27):3774-3776. DOI:10. 6039/j. issn. 1001-0408. 2015. 27. 11.
[3]张清伟,宋佳玉,赵晓,等.超声引导下甲氨蝶呤囊内注射联合宫腔镜治疗剖宫产瘢痕妊娠的临床研究[J].中国妇产科临床杂志,2015,16(2):169-171. DOI:10. 13390/j. issn. 1672-1861. 2015. 02. 024.
[4]李晓娟,周宏伟,宋丽华,等.双侧子宫动脉栓塞联合甲氨蝶呤灌注化疗后B超引导下刮宫术在剖宫产术后瘢痕妊娠中的应用效果分析[J].中国医师杂志,2018,20(1):124-126.DOI:10. 3760/cma. j. issn. 1008-1372. 2018. 01. 034.
[5]梁翠霞,李娟,李杏婵,等.宫腔镜引导下经阴道子宫瘢痕憩室切除术27例体会[J].山东医药,2015,55(30):107. DOI:10. 3969/j. issn. 1002-266X. 2015. 30. 048.
[6] Yamaguchi M,Honda R,Uchino K,et al. Transvaginal methotrexate injection for the treatment of cesarean scar pregnancy:efficacy and subsequent fecundity[J]. J Minim Invasive Gynecol,2014,21(5):877-883. DOI:10. 1016/j. jmig. 2014. 03. 024.
[7]赵彦婷,刘彦肖,杨萍,等.药物联合宫腔镜对剖宫产术后子宫瘢痕妊娠患者生育功能影响[J].现代仪器与医疗,2016,22(2):85-87. DOI:10. 11876/mimt201602032.
[8]马艳,孙玉琴,刘羽. 31例介入合并甲氨蝶呤治疗子宫瘢痕妊娠的分析[J].安徽医科大学学报,2014,49(1):125-127.DOI:10. 19405/j. cnki. issn1000-1492. 2014. 01. 034.
[9] Kelek9i S,Aydog(mu爧S,Aydog(mu爧H,et al. Ineffectual Medical Treatment of Cesarean Scar Ectopic Pregnancy With Systemic Methotrexate:A Report of Two Cases[J]. J Investig Med High Impact Case Rep,2014,2(1):2324709614528903. DOI:10.1177/2324709614528903.
[10] Li YR,Xiao SS,Wan YJ,et al. Analysis of the efficacy of three treatment options for cesarean scar pregnancy management[J]. J Obstet Gynaecol Res,2014,40(11):2146-2151. DOI:10. 1111/jog. 12468.
[11]李长东,冯颖,陈素文,等.宫腔镜、腹腔镜治疗剖宫产瘢痕妊娠72例分析[J].中国工程科学,2014,16(5):20-23. DOI:10. 3969/j. issn. 1009-1742. 2014. 05. 004.
[12]黄华仪,罗月明,许茵.宫腔镜手术治疗内生型剖宫产瘢痕妊娠34例临床分析[J].中国微创外科杂志,2015,15(8):720-722. DOI:10. 3969/j. issn. 1009-6604. 2015. 08. 015.
[13]李娟,干晓琴,林海,等.宫腔镜下清宫术治疗剖宫产瘢痕妊娠前不同预处理方式的疗效分析[J].实用妇产科杂志,2016,32(9):705-708.
[14]范佳颖,谢静颖,卢燕玲,等.宫腔镜联合清宫术治疗内生型剖宫产瘢痕妊娠32例临床分析[J].中国实用妇科与产科杂志,2016,32(7):693-696.
[15] Boza A,Boza B,Api M. Cesarean Scar Pregnancy Managed with Conservative Treatment[J]. Iran J Med Sci,2016,41(5):450-455.