超声监测下清宫术与子宫动脉栓塞后清宫术治疗剖宫产术后子宫瘢痕妊娠的疗效观察
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摘要
目的对比超声监测下清宫术与子宫动脉栓塞后清宫术治疗剖宫产术后子宫瘢痕妊娠(CSP)的疗效,以期为临床治疗方案的选择提供依据。方法选择深圳市龙岗中心医院妇科2015年1月至2018年5月期间收治的78例CSP患者为研究对象,根据随机数表法分为观察组与对照组,每组39例,对照组患者在超声监测下行清宫术治疗,观察组患者则应用子宫动脉栓塞后行清宫术治疗,比较两组患者围手术期出血量、血人绒毛膜促性腺激素(β-HCG)转阴时间、住院时间、疗效及并发症发生情况。结果观察组患者的围手术期出血量、血β-HCG转阴时间及住院时间分别为(11.4±4.6) mL、(17.9±5.3) d、(7.7±2.6) d,明显少于对照组的(38.5±8.1) mL、(21.4±6.7) d、(9.8±3.4) d,差异均有统计学意义(P<0.05);观察组患者的治疗成功率为97.44%,明显高于对照组的87.18%,不良反应发生率为7.69%,明显低于对照组的28.21%,差异均有统计学意义(P<0.05)。结论子宫动脉栓塞后清宫术治疗剖宫产术后子宫瘢痕妊娠,与超声监测下清宫术比较,具有更高的成功率及安全性。
Objective To explore the curative effect of general ultrasound monitoring curettage and uterine curettage after uterine artery embolization(UAE) for cesarean scar pregnancy(CSP), and to provide basis for the selection of clinical treatment. Methods A total of 78 cases of CSP patients admitted to the Department of Gynaecology in Shenzhen Longgang District Central Hospital from January 2015 to May 2018 were selected in this research. According to the random number table method, they were divided into an observation group and a control group, with 39 cases in each group. The control group was treated with curettage under ultrasound monitoring, and the observation group was treated with the uterine curettage after UAE. The two groups of patients were compared for differences in the amount of perioperative bleeding, the time for blood beta human chorionic gonadotropin(β-hCG) conversion to negative, length of hospital stay, curative effects and complications. Results In the observation group, the amount of perioperative bleeding, the time for blood β-hCG conversion to negative, length of hospital stay was(11.4±4.6) mL,(17.9±5.3) days and(7.7±2.6) days, respectively, significantly less than the corresponding(38.5±8.1) mL,(21.4± 6.7) days and(9.8±3.4) days in the control group(P<0.05). The treatment success rate of the observation group was 97.44%, significantly higher than 87.18% for the control group; and the incidence of adverse reactions in the observation group was 7.69%, significantly lower than 28.21% in the control group; both differences were statistically significant(P<0.05). Conclusion Curettage for CSP after uterine artery embolization has higher success rate and safety than only curettage under ultrasound monitoring.
Objective To explore the curative effect of general ultrasound monitoring curettage and uterine curettage after uterine artery embolization(UAE) for cesarean scar pregnancy(CSP), and to provide basis for the selection of clinical treatment. Methods A total of 78 cases of CSP patients admitted to the Department of Gynaecology in Shenzhen Longgang District Central Hospital from January 2015 to May 2018 were selected in this research. According to the random number table method, they were divided into an observation group and a control group, with 39 cases in each group. The control group was treated with curettage under ultrasound monitoring, and the observation group was treated with the uterine curettage after UAE. The two groups of patients were compared for differences in the amount of perioperative bleeding, the time for blood beta human chorionic gonadotropin(β-hCG) conversion to negative, length of hospital stay, curative effects and complications. Results In the observation group, the amount of perioperative bleeding, the time for blood β-hCG conversion to negative, length of hospital stay was(11.4±4.6) mL,(17.9±5.3) days and(7.7±2.6) days, respectively, significantly less than the corresponding(38.5±8.1) mL,(21.4± 6.7) days and(9.8±3.4) days in the control group(P<0.05). The treatment success rate of the observation group was 97.44%, significantly higher than 87.18% for the control group; and the incidence of adverse reactions in the observation group was 7.69%, significantly lower than 28.21% in the control group; both differences were statistically significant(P<0.05). Conclusion Curettage for CSP after uterine artery embolization has higher success rate and safety than only curettage under ultrasound monitoring.
引文
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[12]尹晓燕,王淑玲,高志云,等.超声监测下行剖宫产术后子宫瘢痕早期妊娠人工清宫术的价值[J].海南医学, 2015, 26(18):2766-2767.
[13]王萌.超声在剖宫产术后宫腔内残留物清宫术中的临床应用价值[J].吉林医学, 2015, 36(2):363.
[14]汤慕群,李展妹,张泳珊.甲氨蝶呤妊娠囊内注射联合米非司酮口服在子宫瘢痕妊娠治疗中的应用[J].海南医学, 2017, 28(13):2179-2180.
[15]黄燕,杨鹰.子宫动脉栓塞术在凶险型前置胎盘剖宫产中的疗效观察[J].国际妇产科学杂志, 2014, 41(4):426-428.
[16]莫劲思,董小萍,苏宝兰.子宫动脉栓塞术结合宫腔镜电切在宫颈妊娠大出血治疗中的作用[J].实用医学杂志, 2014, 30(2):274-275.
[17]叶礼新,史永江,李静,等.子宫动脉栓塞术预防子宫切口瘢痕妊娠11例出血效果分析[J].人民军医, 2013, 56(5):582-583.
[18]何鑫,陈薇,张震宇,等.子宫动脉化疗栓塞治疗瘢痕妊娠的Meta分析[J].首都医科大学学报, 2013, 34(2):275-281.
[19]罗红艳,张艳珍.子宫动脉栓塞术和子宫切除术对子宫肌瘤患者卵巢功能的影响研究[J].肿瘤学杂志, 2014, 20(5):432-434.
[2]李丹,李冬梅,马小军,等.基层医院剖宫产率升高的调查分析[J].河北医科大学学报, 2013, 34(4):444-445.
[3]潘春煦,杨鹏. 4117例二次妊娠合并瘢痕子宫产妇剖宫产并发症情况分析[J].山东医药, 2014, 54(2):39-40.
[4]陈勇霞,刘颖,肖倩琨,等.不同方法治疗剖宫产术后子宫瘢痕处妊娠的效果[J].实用医学杂志, 2012, 28(14):2412-2413.
[5]唐建华,黄梦婷.彩色多普勒超声在诊断和治疗剖宫产术后子宫瘢痕妊娠中的应用[J].华夏医学, 2014, 27(4):170-174.
[6]高红莲,蒋荷娟.超声在剖宫产术后子宫瘢痕妊娠诊断及选择性治疗中的应用[J].海南医学, 2013, 24(2):215-217.
[7]陆宣平,陈友国,韩冰.剖宫产术后瘢痕子宫再次妊娠分娩方式的研究进展[J].实用妇产科杂志, 2014, 30(4):260-262.
[8] Shi M, Zhang H, Qi SS, et al. Identifying risk factors for cesarean scar pregnancy:a retrospective study of 79 cases[J]. Ginekol Pol,2018, 89(4):196-200.
[9]胡锐,朱俊勇,袁昊,等.剖宫产术后子宫瘢痕妊娠发病机制的研究进展[J].中华妇产科杂志, 2014, 49(1):61-63.
[10]段薇,于月新. TGF-β1和VEGF在子宫瘢痕中的表达及其与子宫瘢痕愈合的关系[J].中国医科大学学报, 2016, 45(9):777-782.
[11]张子旸,王启峰.剖宫产瘢痕妊娠的病因分析及诊治研究[J].世界临床医学, 2016, 10(9):148.
[12]尹晓燕,王淑玲,高志云,等.超声监测下行剖宫产术后子宫瘢痕早期妊娠人工清宫术的价值[J].海南医学, 2015, 26(18):2766-2767.
[13]王萌.超声在剖宫产术后宫腔内残留物清宫术中的临床应用价值[J].吉林医学, 2015, 36(2):363.
[14]汤慕群,李展妹,张泳珊.甲氨蝶呤妊娠囊内注射联合米非司酮口服在子宫瘢痕妊娠治疗中的应用[J].海南医学, 2017, 28(13):2179-2180.
[15]黄燕,杨鹰.子宫动脉栓塞术在凶险型前置胎盘剖宫产中的疗效观察[J].国际妇产科学杂志, 2014, 41(4):426-428.
[16]莫劲思,董小萍,苏宝兰.子宫动脉栓塞术结合宫腔镜电切在宫颈妊娠大出血治疗中的作用[J].实用医学杂志, 2014, 30(2):274-275.
[17]叶礼新,史永江,李静,等.子宫动脉栓塞术预防子宫切口瘢痕妊娠11例出血效果分析[J].人民军医, 2013, 56(5):582-583.
[18]何鑫,陈薇,张震宇,等.子宫动脉化疗栓塞治疗瘢痕妊娠的Meta分析[J].首都医科大学学报, 2013, 34(2):275-281.
[19]罗红艳,张艳珍.子宫动脉栓塞术和子宫切除术对子宫肌瘤患者卵巢功能的影响研究[J].肿瘤学杂志, 2014, 20(5):432-434.