腹腔镜子宫动脉暂时阻断术与子宫动脉栓塞术预处理治疗Ⅲ型剖宫产瘢痕部位妊娠的效果分析
摘要
目的:探讨腹腔镜子宫动脉暂时阻断术与子宫动脉栓塞术(UAE)预处理在治疗Ⅲ型剖宫产瘢痕部位妊娠(CSP)中的效果。方法:选择2016年1月至2018年4月就诊于南昌大学第一附属医院妇产科的65例经超声及MRI确诊为Ⅲ型CSP患者为研究对象,其中A组31例应用腹腔镜下子宫动脉暂时阻断术后行瘢痕妊娠病灶切除术。B组34例应用UAE预处理后行瘢痕妊娠病灶切除术。比较两组术中出血量、住院时间、住院费用、血β-人绒毛膜促性腺激素(β-hCG)术后第1天较术前下降百分比、月经复潮时间、术后并发症等。结果:两组术中出血量、住院时间、血β-hCG术后第1天下降百分比、月经复潮时间比较差异均无统计学意义(P>0.05);住院费用A组少于B组(P<0.05),B组术后并发症发生率高于A组(P<0.05)。结论:腹腔镜子宫动脉暂时阻断术是Ⅲ型CSP手术治疗中的一种安全、有效、并发症少且较为经济的预处理方法,非紧急情况下可代替UAE。
引文
[1] 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.
[2] 袁岩,戴晴,蔡胜,等.超声对剖宫产瘢痕妊娠的诊断价值[J].中华超声影像学杂志,2010,19(4):321-324.
[3] 苏翠红,李笑天.剖宫产子宫切口憩室的诊疗进展[J].实用妇产科杂志,2013,29(4):390-392.
[4] Roberge S,Demers S,Berghella V,et al.Impact of single-vs doub-le-layer closure on adverse outcomes and uterine scar defect:a systematic review and metaanalysis[J].American Journal of Obstetrics and Gynecology,2014,211(5):453-460.
[5] Jurkovic D,Hillaby K,Woelfer B,et al.First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar[J].Ultrasound Obstet Gynecol,2003,21(3):220-227.
[6] Seow KM,Huang LW,Lin YH,et al.Cesarean scar pregnancy:issues in management[J].Ultrasound Obstet Gynecol,2004,23(3):247-253.
[7] 李燕娜,魏炜,张军.腹腔镜在治疗剖宫产后子宫瘢痕妊娠中的应用[J].实用妇产科杂志,2012,28(4):285-287.
[8] 陈镘如,梅立,谢兰,等.外生型剖宫产瘢痕妊娠三种治疗方法的对比研究[J].实用妇产科杂志,2015,31(4):278-281.
[9] Litwicka K,Greco E.Caesarean scar pregnancy:a review of management options[J].Curr Opin Obstet Gynecol,2013,25(6):456-461.
[10] 陈家莲.子宫动脉暂时阻断在腹腔镜子宫肌瘤剔除术中的应用价值分析[J].河北医学,2014,20(9):1452-1455.
[11] 张庆兵.LM术中子宫动脉暂时阻断的意义分析[J].湖南师范大学学报(医学版),2018,15(2):60-63.
[12] Liang F,He J.Methotrexate-based bilateral uterine arterial chemoembolization for treatment of cesarean scar pregnancy[J].Acta Obstet Gynecol Scand,2010,89(12):1592-1594.
[13] Cao GS,Liu RQ,Liu YY,et al.Menstruation recovery in scar pregnancy patients undergoing UAE and curettage and its influencing factors[J].Medicine(Baltimore),2018,97(11):e9584.
[14] Toor SS.Complication rates and effectiveness of uterine artery embolization in the treatment of symptomatic leiomyomas:a systematic review and Meta-analysis[J].AJR Am J Roentgenol,2012,199(5):1153-1163.
[2] 袁岩,戴晴,蔡胜,等.超声对剖宫产瘢痕妊娠的诊断价值[J].中华超声影像学杂志,2010,19(4):321-324.
[3] 苏翠红,李笑天.剖宫产子宫切口憩室的诊疗进展[J].实用妇产科杂志,2013,29(4):390-392.
[4] Roberge S,Demers S,Berghella V,et al.Impact of single-vs doub-le-layer closure on adverse outcomes and uterine scar defect:a systematic review and metaanalysis[J].American Journal of Obstetrics and Gynecology,2014,211(5):453-460.
[5] Jurkovic D,Hillaby K,Woelfer B,et al.First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment cesarean section scar[J].Ultrasound Obstet Gynecol,2003,21(3):220-227.
[6] Seow KM,Huang LW,Lin YH,et al.Cesarean scar pregnancy:issues in management[J].Ultrasound Obstet Gynecol,2004,23(3):247-253.
[7] 李燕娜,魏炜,张军.腹腔镜在治疗剖宫产后子宫瘢痕妊娠中的应用[J].实用妇产科杂志,2012,28(4):285-287.
[8] 陈镘如,梅立,谢兰,等.外生型剖宫产瘢痕妊娠三种治疗方法的对比研究[J].实用妇产科杂志,2015,31(4):278-281.
[9] Litwicka K,Greco E.Caesarean scar pregnancy:a review of management options[J].Curr Opin Obstet Gynecol,2013,25(6):456-461.
[10] 陈家莲.子宫动脉暂时阻断在腹腔镜子宫肌瘤剔除术中的应用价值分析[J].河北医学,2014,20(9):1452-1455.
[11] 张庆兵.LM术中子宫动脉暂时阻断的意义分析[J].湖南师范大学学报(医学版),2018,15(2):60-63.
[12] Liang F,He J.Methotrexate-based bilateral uterine arterial chemoembolization for treatment of cesarean scar pregnancy[J].Acta Obstet Gynecol Scand,2010,89(12):1592-1594.
[13] Cao GS,Liu RQ,Liu YY,et al.Menstruation recovery in scar pregnancy patients undergoing UAE and curettage and its influencing factors[J].Medicine(Baltimore),2018,97(11):e9584.
[14] Toor SS.Complication rates and effectiveness of uterine artery embolization in the treatment of symptomatic leiomyomas:a systematic review and Meta-analysis[J].AJR Am J Roentgenol,2012,199(5):1153-1163.