选择性应用血管介入技术治疗剖宫产瘢痕妊娠的疗效观察
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摘要
目的探讨选择子宫动脉化疗栓塞术(UACE)作为宫腔镜下瘢痕妊娠清除术前预处理的评价指标及疗效。方法选择2018年1～6月北京妇产医院计划生育科收治的剖宫产瘢痕妊娠(CSP)患者123例为观察组,并根据CSP临床分型及病灶处血流分级情况选择性应用UACE作为术前预处理;选择2015年1～6月收治的CSP患者52例为对照组,对照组患者术前未做风险评估。比较两组CSP患者临床分型的超声指标、孕囊与剖宫产瘢痕处血流信号分级、术中出血量、平均住院日及UACE使用率,并对数据进行统计学分析。结果两组CSP患者的年龄、孕次、流产次、剖宫产次、术中出血量及治疗成功率比较均无统计学差异(P>0.05)。观察组孕囊最大径线显著大于对照组,孕囊距离浆膜层最薄肌层厚度显著薄于对照组(P<0.05);观察组孕囊向膀胱方向外凸情况有32例,占26.0%;对照组8例,占15.4%;观察组平均住院日显著少于对照组(P<0.05);观察组介入率(49.6%)与对照组(84.6%)相比,差异有统计学意义(P<0.05)。结论对CSP术中出血风险进行评估,选择性应用UACE作为宫腔镜手术前预处理,可以使CSP患者从介入治疗中获益,使诊疗过程得到优化,减少人力、物力消耗。
Objective:To evaluate the selection of uterine arterial chemoembolization(UACE)as an evaluation index and efficacy of preoperative preconditioning for hysteroscopic scar pregnancy removal.Methods:A total of 123 patients with cesarean section scar pregnancy(CSP)were admitted in Department of Family Planning,Beijing Obstetrics and Gynecology Hospital from Jan.to Jun.2018 were selected as the observation group.According to the clinical classification of CSP and the blood flow of the lesion,UACE was used as preoperative preconditioning.In addition,52 patients with CSP were admitted from Jan.to Jun.2015 were selected as the control group.The patients in the control group did not undergo risk assessment and selective treatment before surgery.The ultrasound indexes,grade of blood flow signal in the gestational sac and cesarean section scar,intraoperative bleeding volume,average hospitalization days and the use rate of UACE used were compared between the two groups.Results:There were no significant differences in age,gravidity,abortion times,cesarean section times,intraoperative bleeding volume,treatment success rate between the two groups(P>0.05).The maximum diameter of gestational sac in the observation group was significantly larger than that in the control group(P<0.05),and the thickness of the thinnest muscular layer between the gestational sac and the serosa layer was significantly thinner than that in the control group(P<0.05).The protrusion of the gestational sac towards the bladder in the observation group was 32 cases,accounting for 26.0%;there were 8 cases in the control group,accounting for 15.4%.The average hospitalization days in the observation group were significantly less than that in the control group(P<0.05).The intervention rate in the observation group(49.6%)was significant lower than that in control group(84.6%)(P<0.05).Conclusions:Systematic assessment of the bleeding risk of CSP and selective use of UACE as preoperative hysteroscopic pretreatment can benefit CSP patients from interventional therapy,optimize the diagnosis and treatment process,and reduce manpower and material consumption.
Objective:To evaluate the selection of uterine arterial chemoembolization(UACE)as an evaluation index and efficacy of preoperative preconditioning for hysteroscopic scar pregnancy removal.Methods:A total of 123 patients with cesarean section scar pregnancy(CSP)were admitted in Department of Family Planning,Beijing Obstetrics and Gynecology Hospital from Jan.to Jun.2018 were selected as the observation group.According to the clinical classification of CSP and the blood flow of the lesion,UACE was used as preoperative preconditioning.In addition,52 patients with CSP were admitted from Jan.to Jun.2015 were selected as the control group.The patients in the control group did not undergo risk assessment and selective treatment before surgery.The ultrasound indexes,grade of blood flow signal in the gestational sac and cesarean section scar,intraoperative bleeding volume,average hospitalization days and the use rate of UACE used were compared between the two groups.Results:There were no significant differences in age,gravidity,abortion times,cesarean section times,intraoperative bleeding volume,treatment success rate between the two groups(P>0.05).The maximum diameter of gestational sac in the observation group was significantly larger than that in the control group(P<0.05),and the thickness of the thinnest muscular layer between the gestational sac and the serosa layer was significantly thinner than that in the control group(P<0.05).The protrusion of the gestational sac towards the bladder in the observation group was 32 cases,accounting for 26.0%;there were 8 cases in the control group,accounting for 15.4%.The average hospitalization days in the observation group were significantly less than that in the control group(P<0.05).The intervention rate in the observation group(49.6%)was significant lower than that in control group(84.6%)(P<0.05).Conclusions:Systematic assessment of the bleeding risk of CSP and selective use of UACE as preoperative hysteroscopic pretreatment can benefit CSP patients from interventional therapy,optimize the diagnosis and treatment process,and reduce manpower and material consumption.
引文
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[8]郭文波,杨建勇,陈伟,等.子宫肌瘤栓塞中误栓卵巢支对卵巢功能影响[J].中华放射学杂志,2005,39:934-937.
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[10]王乔,赵霞.剖宫产瘢痕妊娠的介入治疗及疗效评价[J].实用妇产科杂志,2014,30:245-247.
[11]王乔,赵霞.剖宫产瘢痕妊娠的介入治疗[J].中国实用妇科与产科杂志,2018,8:847-850.
[12]白亮亮,李甜甜,李宗明,等.刮宫术前行预防性子宫动脉栓塞治疗瘢痕妊娠的必要性[J].中国介入影像与治疗学,2018,15:47-50.
[13]阿斯燕.努斯拉提,林开清,林俊.子宫动脉栓塞术联合清宫术治疗剖宫产瘢痕妊娠大量阴道出血的影响因素分析[J].中国计划生育学杂志,2016,24:828-829.
[14] Yang XY,Yu H,Li KM,et al.Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy[J].BJOG,2010,117:990-996.
[15]章晓乐,何培芝,胡春花,等.子宫动脉栓塞化疗后内镜下孕囊定位吸引术治疗剖宫产切口妊娠临床研究[J].生殖医学杂志,2016,25:943-946.
[2] Zhuang Y,Huang L.Uterine artery embolization compared with methotrexate for the management of pregnancy implanted within a cesarean scar[J].Am J Obstet Gynecol,2009,201:15.e1-3.
[3]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,2012,92:1731-1733.
[4]金力,陈蔚琳,周应芳.剖宫产术后子宫瘢痕妊娠诊治专家共识(2016)[J].中华妇产科杂志,2016,51:568-572.
[5] Adler DD,Carson PL,Rubin JM,et al.Doppler ultrasound color flow imaging in the study of breast cancer:Preliminary findings[J].Ultrasound Med Biol,1990,16:553-559.
[6]刘凯杰,李翠兰,莫薛唐,等.剖宫产术后瘢痕妊娠临床诊治进展[J].生殖医学杂志,2016,25:660-663.
[7]马翠,陈素文.子宫动脉化疗栓塞术对剖宫产瘢痕妊娠患者卵巢功能的影响[J].生殖医学杂志,2017,27:1123-1126.
[8]郭文波,杨建勇,陈伟,等.子宫肌瘤栓塞中误栓卵巢支对卵巢功能影响[J].中华放射学杂志,2005,39:934-937.
[9]欧阳栋,朱斌,何晓音.子宫动脉栓塞术治疗剖宫产后切口妊娠26例临床分析[J].中国内镜杂志,2013,19:631-635.
[10]王乔,赵霞.剖宫产瘢痕妊娠的介入治疗及疗效评价[J].实用妇产科杂志,2014,30:245-247.
[11]王乔,赵霞.剖宫产瘢痕妊娠的介入治疗[J].中国实用妇科与产科杂志,2018,8:847-850.
[12]白亮亮,李甜甜,李宗明,等.刮宫术前行预防性子宫动脉栓塞治疗瘢痕妊娠的必要性[J].中国介入影像与治疗学,2018,15:47-50.
[13]阿斯燕.努斯拉提,林开清,林俊.子宫动脉栓塞术联合清宫术治疗剖宫产瘢痕妊娠大量阴道出血的影响因素分析[J].中国计划生育学杂志,2016,24:828-829.
[14] Yang XY,Yu H,Li KM,et al.Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy[J].BJOG,2010,117:990-996.
[15]章晓乐,何培芝,胡春花,等.子宫动脉栓塞化疗后内镜下孕囊定位吸引术治疗剖宫产切口妊娠临床研究[J].生殖医学杂志,2016,25:943-946.