B超监测下清宫术与切开取胚术治疗内生型子宫瘢痕妊娠的疗效比较
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摘要
目的比较B超监测下清宫术与切开取胚术治疗内生型子宫瘢痕妊娠(CSP)的效果。方法回顾性分析78例内生型CSP患者的临床资料,按手术方式不同分为清宫术组47例和取胚术组31例。清宫术组在B超引导下行清宫术,取胚术组开腹或在腹腔镜下行切开子宫取胚术。比较两组术中出血量、手术时间、术后住院时间、住院费用、血β人绒毛膜促性腺激素(β-HCG)值降至正常所需时间、术后月经恢复正常所需时间及治疗效果。结果清宫术组术中出血量、手术时间及住院费用均少于取胚术组(均P <0. 05),两组术后住院时间、血β-HCG值降至正常所需时间及术后月经恢复正常所需时间及治疗成功率比较,差异均无统计学意义(均P> 0. 05)。结论 B超监测下清宫术与切开子宫取胚术治疗内生型CSP均安全有效,但B超监测下清宫术术中出血量、手术时间及住院费用少。
Objective To compare the efficacy between ultrasound-guided uterine curettage and incisional embryo removal in treating endogenous cesarean scar pregnancy( CSP). Methods Clinical data of 78 patients with endogenous CSP were retrospectively analyzed. The patients were divided into uterine curettage group( n = 47) or embryo removal group( n = 31) according to the operation method. The uterine curettage group underwent ultrasound-guided uterine curettage,while the embryo removal group underwent open or laparoscopic hysterotomy and embryo removal. The related indices were compared between the two groups,including intraoperative blood loss,operation time,postoperative hospital stay,hospitalization cost,duration for normalization of β human chorionic gonadotropin( β-HCG) level and menstruation after operation,and therapeutic effect. Results The intraoperative blood loss,operation time and hospitalization cost of the uterine curettage group were less than those of the embryo removal group( all P < 0. 05).There were no statistical differences in the postoperative hospital stay,or the duration for normalization of β-HCG level or menstruation after operation between the two groups( all P > 0. 05). Conclusion It is safe and effective to treat endogenous CSP by either ultrasound-guided uterine curettage or incisional embryo removal,however,ultrasound-guided uterine curettage obtains less intraoperative blood loss,operation time and hospitalization cost.
Objective To compare the efficacy between ultrasound-guided uterine curettage and incisional embryo removal in treating endogenous cesarean scar pregnancy( CSP). Methods Clinical data of 78 patients with endogenous CSP were retrospectively analyzed. The patients were divided into uterine curettage group( n = 47) or embryo removal group( n = 31) according to the operation method. The uterine curettage group underwent ultrasound-guided uterine curettage,while the embryo removal group underwent open or laparoscopic hysterotomy and embryo removal. The related indices were compared between the two groups,including intraoperative blood loss,operation time,postoperative hospital stay,hospitalization cost,duration for normalization of β human chorionic gonadotropin( β-HCG) level and menstruation after operation,and therapeutic effect. Results The intraoperative blood loss,operation time and hospitalization cost of the uterine curettage group were less than those of the embryo removal group( all P < 0. 05).There were no statistical differences in the postoperative hospital stay,or the duration for normalization of β-HCG level or menstruation after operation between the two groups( all P > 0. 05). Conclusion It is safe and effective to treat endogenous CSP by either ultrasound-guided uterine curettage or incisional embryo removal,however,ultrasound-guided uterine curettage obtains less intraoperative blood loss,operation time and hospitalization cost.
引文
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[11]梁健梅.腹腔镜子宫切口瘢痕妊娠病灶清除术对剖宫产切口瘢痕妊娠患者的疗效及安全性分析[J].齐齐哈尔医学院学报,2016,37(10):1 321-1 322.
[12]王克芳,王菊荣,李斌.腹腔镜手术治疗剖宫产术后子宫瘢痕部位妊娠[J].中国微创外科杂志,2011,16(6):496-497,501.
[13]周应芳,杨慧霞.重视剖宫产术后子宫瘢痕妊娠的预防和处置[J].中华妇产科杂志,2014,49(1):3-5.
[2]彭雪梅,何飞,叶肖云.不同途径治疗剖宫产术后子宫瘢痕妊娠的临床疗效分析[J].中国医学工程,2017,25(9):65-67.
[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(25):1 731-1 733.
[4]张利玲.宫腔镜在治疗内生型剖宫产瘢痕妊娠中的应用效果观察[J].临床合理用药杂志,2016,9(24):111-113.
[5]王丽梅,卫炜,孙胜男,等.瘢痕妊娠72例临床诊治分析[J].中国妇幼保健,2017,32(10):2 084-2 086.
[6] Vial Y,Petignat P,Hohlfeld P. Pregnancy in a cesarean scar[J]. Ultrasound Obstet Gynecol,2000,16(6):592-593.
[7] Smith A,Ash A,Maxwell D. Sonographic diagnosis of cesarean scar pregnancy at 16 weeks[J]. J Clin Ultrasound,2007,35(4):212-215.
[8] Godin PA,Bassil S,Donnez J. An ectopic pregnancy developing in a previous caesarian section scar[J]. Fertil Steril,1997,67(2):398-400.
[9]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妊娠诊治专家共识(2016)[J].中华妇产科杂志,2016,51(8):568-572.
[10] Larsen JV,Solomon MH. Pregnancy in a uterine scar sacculus--an unusual cause of postabortal haemorrhage. A case report[J]. S Afr Med J,1978,53(4):142-143.
[11]梁健梅.腹腔镜子宫切口瘢痕妊娠病灶清除术对剖宫产切口瘢痕妊娠患者的疗效及安全性分析[J].齐齐哈尔医学院学报,2016,37(10):1 321-1 322.
[12]王克芳,王菊荣,李斌.腹腔镜手术治疗剖宫产术后子宫瘢痕部位妊娠[J].中国微创外科杂志,2011,16(6):496-497,501.
[13]周应芳,杨慧霞.重视剖宫产术后子宫瘢痕妊娠的预防和处置[J].中华妇产科杂志,2014,49(1):3-5.