摘要
目的 探讨不同手术方式治疗剖宫产瘢痕妊娠的临床疗效、术后人绒毛膜促性腺激素β亚单位（β-hCG）下降趋势及不同治疗方法的适应证.方法 通过前瞻性队列研究,对2013年6月至2014年12月在北京妇产医院计划生育科,采用不同手术方式治疗的120例剖宫产瘢痕妊娠患者的临床资料进行分析,120例中7例行B超下清宫术,63例行子宫动脉栓塞术（UAE）＋宫腔镜下妊娠胚物清除术,41例行UAE＋B超或腹腔镜监测下宫腔镜下妊娠胚物清除术,9例行UAE＋宫腹腔镜联合瘢痕妊娠切除及子宫修补术,分析不同手术方式的临床疗效及术后不同时期血hCG的下降趋势.结果 （1）剖宫产瘢痕妊娠患者不同手术方式治疗术后48 h、术后1周及术后2周血β-hCG下降百分比的平均值分别为（84.5±9.7）％、（97.7±3.2）％及（99.6±1.2）％,术后血β-hCG水平降至正常时间为（22.4 ±6.7）d.（2）不同手术方式治疗后患者出血量及住院时间差异有统计学意义.（3）血β-hCG下降百分比在不同手术方法与术后恢复时间的交互作用分析差异有统计学意义（P＜0.01）,B超下清宫术后血β-hCG下降百分比低于其他组（P＜0.05）.结论 剖宫产瘢痕妊娠患者血β-hCG水平在术后3周左右降至正常水平;对于剖宫产瘢痕妊娠患者手术方式的选择,应依据胎囊着床瘢痕部位的程度、胎囊与子宫浆膜层最薄处肌层厚度、局部血流情况、血β-hCG水平、胎囊大小、突向膀胱情况及患者生育要求等来决定.
Objective To explore the clinical effect of different surgical methods in the treatment of cesarean scar pregnancy,the decline trend of human chorionic gonadotropin （hCG） and the indications of different treatment methods.Methods This study was a prospective cohort study.The clinical data of 120 patients with cesarean scar pregnancy who were treated with four different surgical methods in the Beijing Obstetrics and Gynecology Hospital from June 2013 to December 2014 were collected.Seven cases ultrasonic curettage,63 cases uterine arterial embolization （UAE） with hysteroscopic pregnancy embryo removal surgery,41 cases UAE ＋ B-ultrasound or laparoscopic monitoring hysteroscopic pregnancy embryo clearance surgery and 9 cases UAE ＋ hysteroscopic and laparoscopic removal of pregnancy scar and uterine repair.The clinical efficacy of different surgical methods and the decrease trend of serum HCG in postoperative period were analyzed.Results （1） The levels of serum beta hCG in patients with cesarean scar pregnancy after different surgical treatments decreased （84.5 ± 9.7） %,（97.7 ± 3.2） % and （99.6 ± 1.2） % after the 2 days,7 days and 14 days respectively.The average time of blood beta hCG level dropped to normal was （22.4 ± 6.7） d.（2） There was a significant difference in the amount of bleeding and the time of hospitalization among the patients treated with different surgical methods.（3） There was a significant difference in the analysis of the decline percentage rate of serum beta hCG under the interactive effect between different surgical methods and postoperative recovery time （P 〈 0.01）.Conclusion The level of serum beta hCG in patients with cesarean scar pregnancy were reduced to normal range after 3 weeks of operation.The choice of surgical approach should be based on the degree of implantation of embryo sac scar,the thinnest muscle thickness,local blood flow,serum beta hCG levels,gestational sac size,process to the bladder and fertility desire to determine.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第29期2332-2335,共4页
National Medical Journal of China
基金
北京市科委首都市民健康项目培育（Z131100006813034）
北京市卫生系统高层次卫生人才培养计划（2013-3-029）
