阴式修补术治疗Ⅱ型子宫瘢痕妊娠的临床疗效分析
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摘要
目的探讨阴式修补术治疗Ⅱ型子宫瘢痕妊娠的临床疗效。方法选择2016年7月至2017年7月我院妇产科确诊收治的157例Ⅱ型子宫瘢痕妊娠(CSP)患者作为研究对象,按手术方法的不同分为清宫术组87例,阴式修补术组70例,比较2组患者手术出血量、手术时间、住院时间、手术前后血人绒毛膜促性腺激素(β-HCG)水平、血β-HCG恢复至正常水平时间、手术前后血红蛋白(HB)水平、月经恢复时间、应激反应、炎性反应以及手术并发症。结果清宫术组患者术中出血量、手术时间以及住院时间少于阴式修补术组,2组比较差异有统计学意义(P<0.05);清宫术组患者术后血β-HCG恢复至正常时间长于阴式修补术组,差异有统计学意义(P<0.05); 2组患者术后Hb水平差异无统计学意义(P>0.05);阴式修补术组患者月经恢复时间短于清宫术组,差异有统计学意义(P<0.05);阴式修补术组患者术后肾上腺素(E)、皮质醇(Cor)水平低于清宫术组,促甲状腺激素(TSH)水平高于清宫术组,差异有统计学意义(P<0.05);阴式修补术组患者术后IL-2、IL-6与IL-8水平低于清宫术组,C反应蛋白(CRP)水平高于清宫术组,差异有统计学意义(P<0.05);清宫术组术后并发症发生率高于阴式修补术组,差异有统计学意义(P<0.05)。结论阴式修补术有利于缩短患者血β-HCG恢复正常时间以及月经回溯时间,加快患者机体内炎性因子以及激素恢复至正常水平,降低了术后并发症的发生率。
Objective To explore the clinical efficacy of vaginal hysterectomy and uterine scar repair in the treatment of type Ⅱ cesarean scar pregnancy.Methods A total of 157 patients with type Ⅱ cesarean scar pregnancy(CSP) admitted to our obstetrics and gynecology department of our hospital from July 2016 to July 2017 were selected as research subjects.They were divided into ultrasound curettage group(n = 87) and vaginal repair group(n = 70) according to different surgical methods.The surgical bleeding volume,operative time,hospital stay and human chorionic gonadotropin(β-HCG) level before and after operation,the time of blood β-HCG returning to normal level,hemoglobin(HB) level before and after operation,menstrual recovery time,stress response,inflammatory response and surgical complications were compared between the two groups.Results The intraoperative blood loss volume,operative time and hospital stay in ultrasound curettage group were lower than those in vaginal repair group,the difference was significant(P<0.05).The time of blood β-HCG returning to normal level in vaginal repair group after operation was shorter than that in ultrasound curettage group,the difference was significant(P<0.05).There was no significant difference in the HB level between the two groups(P>0.05).The menstrual recovery time in vaginal repair group was shorter than that in ultrasound curettage group,the difference was significant(P<0.05).The levels of postoperative epinephrine(E)and cortisol(Cor) in vaginal repair group after operation were lower than those in ultrasound curettage group,while the level of thyroid stimulating hormone(TSH) was higher than that in ultrasound curettage group,the difference was significant(P<0.05).The levels of IL-2,IL-6 and IL-8 in vaginal repair group after operation were lower than those in ultrasound curettage group while the level of C-reactive protein(CRP) was higher than that in ultrasound curettage group,the difference was significant(P<0.05).The incidence rate of postoperative complications in ultrasound curettage group was higher than that in vaginal repair group(P<0.05).Conclusion Vaginal repair is more beneficial to shortern the time of blood β-HCG returning to normal level and menstrual recovery time,promote the inflammatory factor and hormone recovery to a normal level,and reduce the incidence of complication.
Objective To explore the clinical efficacy of vaginal hysterectomy and uterine scar repair in the treatment of type Ⅱ cesarean scar pregnancy.Methods A total of 157 patients with type Ⅱ cesarean scar pregnancy(CSP) admitted to our obstetrics and gynecology department of our hospital from July 2016 to July 2017 were selected as research subjects.They were divided into ultrasound curettage group(n = 87) and vaginal repair group(n = 70) according to different surgical methods.The surgical bleeding volume,operative time,hospital stay and human chorionic gonadotropin(β-HCG) level before and after operation,the time of blood β-HCG returning to normal level,hemoglobin(HB) level before and after operation,menstrual recovery time,stress response,inflammatory response and surgical complications were compared between the two groups.Results The intraoperative blood loss volume,operative time and hospital stay in ultrasound curettage group were lower than those in vaginal repair group,the difference was significant(P<0.05).The time of blood β-HCG returning to normal level in vaginal repair group after operation was shorter than that in ultrasound curettage group,the difference was significant(P<0.05).There was no significant difference in the HB level between the two groups(P>0.05).The menstrual recovery time in vaginal repair group was shorter than that in ultrasound curettage group,the difference was significant(P<0.05).The levels of postoperative epinephrine(E)and cortisol(Cor) in vaginal repair group after operation were lower than those in ultrasound curettage group,while the level of thyroid stimulating hormone(TSH) was higher than that in ultrasound curettage group,the difference was significant(P<0.05).The levels of IL-2,IL-6 and IL-8 in vaginal repair group after operation were lower than those in ultrasound curettage group while the level of C-reactive protein(CRP) was higher than that in ultrasound curettage group,the difference was significant(P<0.05).The incidence rate of postoperative complications in ultrasound curettage group was higher than that in vaginal repair group(P<0.05).Conclusion Vaginal repair is more beneficial to shortern the time of blood β-HCG returning to normal level and menstrual recovery time,promote the inflammatory factor and hormone recovery to a normal level,and reduce the incidence of complication.
引文
[1]殷丽丽,杨清.剖宫产瘢痕妊娠研究进展[J].中国实用妇科与产科杂志,2015,31(4):361-365.doi:1005-2216(2015)04-0316-05.
[2]Seow KM,Huang LW,Lin YH,et al.Cesarean scar pregnancy:issues in management[J].Ultrasound Obstet Gynecol,2010,23(3):247-253.doi:10.1002/uog.974.
[3]龙起珏,蔡健.剖宫产瘢痕妊娠诊断及治疗进展[J].医学综述,2017,23(5):962-965.doi:10.3969/j.issn.1006-2084.2017.05.028.
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[5]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].全科医学临床与教育,2017,51(1):5-9.doi:10.3760/cma.j.issn.0529-567x.2016.08.003.
[6]刘志玲,梁春燕,付爱民,等.宫腔镜治疗剖宫产术后子宫瘢痕妊娠的临床观察[J].现代中西医结合杂志,2015,24(20):2204-2206.doi:10.3969/j.issn.1008-8849.2015.20.013.
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[8]陈晓端,石一复.剖宫产后瘢痕部位相关病变临床及病理改变[J].中华病理学杂志,2016,45(10):731-733.doi:10.3760/cma.j.issn.0529-5807.2016.10.018.
[9]庄粤冰.经阴道病灶切除术治疗32例子宫瘢痕妊娠的临床分析[J].现代妇产科进展,2016,25(4):296-297.doi:10.13283/j.cnki.xdfckjz.2016.04.014.
[10]Pan Y,Liu MB.The value of hysteroscopic management of cesarean scar pregnancy:a report of 44 cases[J].Taiwan J Obstet Gynecol,2017,56(2):139-142.doi:10.1016/j.tjog.2016.06.020.
[11]Petersen KB,Hoffmann E,Larsen CR,et al.Cesarean scar pregnancy:a systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.doi:10.1016/j.fertnstert.2015.12.130.
[12]Birch PK,Hoffmann E,Rifbjerg LC,et al.Cesarean scar pregnancy:a systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.doi:10.1016/j.fertnstert.2015.12.130.
[13]Hudece k,FelsingerováZ,Felsinger M,et al.Laparoscopic treatment of cesarean scar ectopic pregnancy[J].J Gynecol Surg,2014,30(5):309-311.doi:10.1089/gyn.2014.0005.
[14]Huanxiao Z,Shuqin C,Hongye J,et al.Transvaginal hys-terotomy for cesarean scar pregnancy in 40 consecutive cases[J].Gynecol Surg,2015,12(1):45-51 doi:10.1007/s10397-014-0863-3.
[15]曾薇薇,金平,古衍,等.三种术式治疗Ⅱ型子宫瘢痕妊娠70例临床分析[J].现代妇产科进展,2017,26(8):616-618.doi:10.13283/j.cnki.xdfckjz.2017.08.013.
[16]马志红,赵曼曼,王丹阳.经阴道病灶切除术治疗剖宫产子宫瘢痕妊娠临床病例分析[J].现代妇产科进展,2015,24(10):772-774.doi:10.13283/j.cnki.xdfckjz.2015.10.014.
[17]朱洁云,黄敏,陈翠茹.经阴道剖宫产瘢痕妊娠病灶切除术30例临床分析[J].中国微创外科杂志,2017,17(7):668-669.doi:10.3969/j.issn.1009-6604.2017.07.025.
[18]Chung JP,Haines CJ,Kong GW.Long-term reproductive outcome after hysteroscopic proximal tubal cannulation-an outcome analysis[J].Aust N Z J Obstet Gynaecol,2012,52(5):470-475.doi:10.1111/j.1479-828X.2012.01479.x.
[19]单莉莉,乐爱文,肖天慧,等.经阴道子宫下段切开取胚与子宫动脉栓塞术治疗剖宫产瘢痕妊娠的比较性研究[J].中国微创外科杂志,2013,13(7):611-613.doi:10.3969/j.issn.1009-6604.2013.07.011.
[20]容彩兰,唐春艳.腹腔镜下手术与开腹手术治疗子宫肌瘤术后炎性应激反应的对比研究[J].中国医学装备,2014,11(11):111-114.doi:10.3969/J.ISSN.1672-8270.2014.11.041.
[21]彭辉煌,吴建伟,杨国敬.IL-1、IL-6和CRP对四肢大面积软组织创伤预后的影响[J].中国医师杂志,2013,15(12):1609-1612.doi:10.3760/cma.j.issn.1008-1372.2013.12.007.
[22]An LF,Zhang XH,Sun XT,et al.Unexplained infertility patients have increased serum IL-2,IL-4,IL-6,IL-8,IL-21,TNFα,IFNγand increased Tfh/CD4 T cell ratio:increased Tfh and IL-21 strongly correlate with presence of autoantibodies[J].Immuno Inves,2015,44(2):1-10.doi:10.3109/08820139.2014.932377.
[2]Seow KM,Huang LW,Lin YH,et al.Cesarean scar pregnancy:issues in management[J].Ultrasound Obstet Gynecol,2010,23(3):247-253.doi:10.1002/uog.974.
[3]龙起珏,蔡健.剖宫产瘢痕妊娠诊断及治疗进展[J].医学综述,2017,23(5):962-965.doi:10.3969/j.issn.1006-2084.2017.05.028.
[4]Timor tritsch IE,Monteagudo A.Unforeseen consequences of the increasing rate of cesarean deliveries:early placenta accreta and cesarean scar pregnancy.A review[J].Am J Obstet Gynecol,2012,207(1):14-29.doi:10.1016/j.ajog.2012.03.007.
[5]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].全科医学临床与教育,2017,51(1):5-9.doi:10.3760/cma.j.issn.0529-567x.2016.08.003.
[6]刘志玲,梁春燕,付爱民,等.宫腔镜治疗剖宫产术后子宫瘢痕妊娠的临床观察[J].现代中西医结合杂志,2015,24(20):2204-2206.doi:10.3969/j.issn.1008-8849.2015.20.013.
[7]Vervoort AJ,Uittenbogaard LB,Hehenkamp WJ,et al.Why do niches develop in Caesarean uterine scars?Hypotheses on the aetiology of niche development.[J].Hum Reprod,2015,30(12):2695-2702.doi:10.1093/humrep/dev240.
[8]陈晓端,石一复.剖宫产后瘢痕部位相关病变临床及病理改变[J].中华病理学杂志,2016,45(10):731-733.doi:10.3760/cma.j.issn.0529-5807.2016.10.018.
[9]庄粤冰.经阴道病灶切除术治疗32例子宫瘢痕妊娠的临床分析[J].现代妇产科进展,2016,25(4):296-297.doi:10.13283/j.cnki.xdfckjz.2016.04.014.
[10]Pan Y,Liu MB.The value of hysteroscopic management of cesarean scar pregnancy:a report of 44 cases[J].Taiwan J Obstet Gynecol,2017,56(2):139-142.doi:10.1016/j.tjog.2016.06.020.
[11]Petersen KB,Hoffmann E,Larsen CR,et al.Cesarean scar pregnancy:a systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.doi:10.1016/j.fertnstert.2015.12.130.
[12]Birch PK,Hoffmann E,Rifbjerg LC,et al.Cesarean scar pregnancy:a systematic review of treatment studies[J].Fertil Steril,2016,105(4):958-967.doi:10.1016/j.fertnstert.2015.12.130.
[13]Hudece k,FelsingerováZ,Felsinger M,et al.Laparoscopic treatment of cesarean scar ectopic pregnancy[J].J Gynecol Surg,2014,30(5):309-311.doi:10.1089/gyn.2014.0005.
[14]Huanxiao Z,Shuqin C,Hongye J,et al.Transvaginal hys-terotomy for cesarean scar pregnancy in 40 consecutive cases[J].Gynecol Surg,2015,12(1):45-51 doi:10.1007/s10397-014-0863-3.
[15]曾薇薇,金平,古衍,等.三种术式治疗Ⅱ型子宫瘢痕妊娠70例临床分析[J].现代妇产科进展,2017,26(8):616-618.doi:10.13283/j.cnki.xdfckjz.2017.08.013.
[16]马志红,赵曼曼,王丹阳.经阴道病灶切除术治疗剖宫产子宫瘢痕妊娠临床病例分析[J].现代妇产科进展,2015,24(10):772-774.doi:10.13283/j.cnki.xdfckjz.2015.10.014.
[17]朱洁云,黄敏,陈翠茹.经阴道剖宫产瘢痕妊娠病灶切除术30例临床分析[J].中国微创外科杂志,2017,17(7):668-669.doi:10.3969/j.issn.1009-6604.2017.07.025.
[18]Chung JP,Haines CJ,Kong GW.Long-term reproductive outcome after hysteroscopic proximal tubal cannulation-an outcome analysis[J].Aust N Z J Obstet Gynaecol,2012,52(5):470-475.doi:10.1111/j.1479-828X.2012.01479.x.
[19]单莉莉,乐爱文,肖天慧,等.经阴道子宫下段切开取胚与子宫动脉栓塞术治疗剖宫产瘢痕妊娠的比较性研究[J].中国微创外科杂志,2013,13(7):611-613.doi:10.3969/j.issn.1009-6604.2013.07.011.
[20]容彩兰,唐春艳.腹腔镜下手术与开腹手术治疗子宫肌瘤术后炎性应激反应的对比研究[J].中国医学装备,2014,11(11):111-114.doi:10.3969/J.ISSN.1672-8270.2014.11.041.
[21]彭辉煌,吴建伟,杨国敬.IL-1、IL-6和CRP对四肢大面积软组织创伤预后的影响[J].中国医师杂志,2013,15(12):1609-1612.doi:10.3760/cma.j.issn.1008-1372.2013.12.007.
[22]An LF,Zhang XH,Sun XT,et al.Unexplained infertility patients have increased serum IL-2,IL-4,IL-6,IL-8,IL-21,TNFα,IFNγand increased Tfh/CD4 T cell ratio:increased Tfh and IL-21 strongly correlate with presence of autoantibodies[J].Immuno Inves,2015,44(2):1-10.doi:10.3109/08820139.2014.932377.