宫腔镜联合子宫动脉栓塞术在内生型瘢痕处妊娠中的疗效分析
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摘要
目的:研究宫腔镜联合子宫动脉栓塞术治疗内生型瘢痕处妊娠的疗效分析。方法:选取2014年1月至2018年6月在本院住院的46例内生型瘢痕处妊娠患者,入院后均行双侧子宫动脉栓塞术,其中12例行宫腔镜下病灶电切术,34例行B超引导下清宫术,对比两组患者的手术时间、术中出血量、住院时间、住院费用及术后血绒毛膜促性腺激素(HCG)恢复正常时间。结果:宫腔镜联合子宫动脉栓塞组与清宫联合子宫动脉栓塞组相比,术后血HCG转阴时间及住院时间均缩短,两者差异有统计学意义(P<0.05),两者在住院费用上无统计学差异。结论:瘢痕处妊娠患者易出现术中大出血,手术风险大,术前行子宫动脉栓塞术可明显降低出血风险,宫腔镜手术能缩短住院时间,治愈率高,避免二次手术,保留患者的生育能力。
Objective:To explore the comparison between two treatment regimens after uterine artery embolization. Methods: Total of 45 patients with pregnancy scar were collected in January 2014 to January 2018. After admission in the hospital,bilateral uterine artery embolization was performed.11 underwent lesion under hysteroscopy electricity cut method,and 34 underwent ultrasound guided by uterine curettage. Intraoperative bleeding, operation time,postoperative blood human chorionic gonadotropin(HCG) returned to normal time, length of hospital stay and hospitalization expenses, etc between the two groups were compared. Results: There was statistically significant difference between the inpatient time and the hospitalization time of HCG(P < 0.05) in the patients with hysteroscopy group compared with those in the uterine curettage group(P < 0.05), and there was no statistical difference in the hospitalization expenses.Conclusion:Scar in pregnancy patients prone to bleeding, high risk of operation, the preoperative uterine artery embolization may reduce the risk of bleeding, hysteroscopy surgery could shorten the length of hospital stay, cure rate is high, avoid secondary operation, keep the patient's fertility.
Objective:To explore the comparison between two treatment regimens after uterine artery embolization. Methods: Total of 45 patients with pregnancy scar were collected in January 2014 to January 2018. After admission in the hospital,bilateral uterine artery embolization was performed.11 underwent lesion under hysteroscopy electricity cut method,and 34 underwent ultrasound guided by uterine curettage. Intraoperative bleeding, operation time,postoperative blood human chorionic gonadotropin(HCG) returned to normal time, length of hospital stay and hospitalization expenses, etc between the two groups were compared. Results: There was statistically significant difference between the inpatient time and the hospitalization time of HCG(P < 0.05) in the patients with hysteroscopy group compared with those in the uterine curettage group(P < 0.05), and there was no statistical difference in the hospitalization expenses.Conclusion:Scar in pregnancy patients prone to bleeding, high risk of operation, the preoperative uterine artery embolization may reduce the risk of bleeding, hysteroscopy surgery could shorten the length of hospital stay, cure rate is high, avoid secondary operation, keep the patient's fertility.
引文
[1] Natalia G,Ogas T.Cesarean Scar Pregnancy:A Systematic Review[J].Journal of Minimally Invasive Gynecology,2017,24(05):731-738.
[2] 陈春林.剖宫产瘢痕部位妊娠的诊治进展[J].实用妇产科杂志,2017,04(33):245-246.
[3] 中华医学会妇产科学分会计划生育学组.剖宫产术后瘢痕妊娠诊治专家共识(2016)[J].中华妇产科学杂志,2016,51(08):568-572.
[4] 王秦芳,仝亚红.子宫动脉栓塞术治疗剖宫产子宫瘢痕妊娠的临床疗效及影响因素研究实用临床医药杂志,2017,21(05):133-134.
[5] Baoli Q,Zhenyu Z,Yanfang L.Uterine Artery Embolization Versus Methotrexate for Cesarean Scar Pregnancy in a Chinese Population:A Meta-analysis[J].Journal of Minimally Invasive Gynecology,2016,23(07):1040-1048.
[6] 徐佳,孟跃进,顾晓丽,等.宫腔镜电切术治疗剖宫产术后子宫瘢痕妊娠的疗效分析[J].郑州大学学报(医学版),2014,(06):886-888.
[7] 向阳.关于剖宫产瘢痕妊娠的分型与治疗方法的选择[J].中国妇产科临床杂志,2012,13(06):401-403.
[8] 周亭亭,王晓慧,聂影,等,剖宫产术后瘢痕妊娠的诊疗进展当代医学,2017,36(23),182-184.
[9] Forlani F,Orlando G.Foley balloon versus uterine anery embolisation(UAE) as hemostatic tool in the treatment of caesarean scar pregnancy(CSP)[J].Ultrasound Obstet Gynecol,2016,48(01):371.
[10]邵华江,马建婷,苏晓敏,等.剖宫产瘢痕妊娠个体化治疗61例分析[J].中华产科急救杂志,2013,02(02):127-131.
[2] 陈春林.剖宫产瘢痕部位妊娠的诊治进展[J].实用妇产科杂志,2017,04(33):245-246.
[3] 中华医学会妇产科学分会计划生育学组.剖宫产术后瘢痕妊娠诊治专家共识(2016)[J].中华妇产科学杂志,2016,51(08):568-572.
[4] 王秦芳,仝亚红.子宫动脉栓塞术治疗剖宫产子宫瘢痕妊娠的临床疗效及影响因素研究实用临床医药杂志,2017,21(05):133-134.
[5] Baoli Q,Zhenyu Z,Yanfang L.Uterine Artery Embolization Versus Methotrexate for Cesarean Scar Pregnancy in a Chinese Population:A Meta-analysis[J].Journal of Minimally Invasive Gynecology,2016,23(07):1040-1048.
[6] 徐佳,孟跃进,顾晓丽,等.宫腔镜电切术治疗剖宫产术后子宫瘢痕妊娠的疗效分析[J].郑州大学学报(医学版),2014,(06):886-888.
[7] 向阳.关于剖宫产瘢痕妊娠的分型与治疗方法的选择[J].中国妇产科临床杂志,2012,13(06):401-403.
[8] 周亭亭,王晓慧,聂影,等,剖宫产术后瘢痕妊娠的诊疗进展当代医学,2017,36(23),182-184.
[9] Forlani F,Orlando G.Foley balloon versus uterine anery embolisation(UAE) as hemostatic tool in the treatment of caesarean scar pregnancy(CSP)[J].Ultrasound Obstet Gynecol,2016,48(01):371.
[10]邵华江,马建婷,苏晓敏,等.剖宫产瘢痕妊娠个体化治疗61例分析[J].中华产科急救杂志,2013,02(02):127-131.