摘要
目的研究剖宫产瘢痕妊娠(CSP)患者早孕期手术治疗的最佳方式,形成一个系统的治理原则,为临床医生提供治疗参考依据。方法回顾性分析2012年5月至2016年5月邢台市第三医院妇科收治的26例诊断为剖宫产瘢痕妊娠患者,应用经阴道彩色多普勒超声诊断。依据患者术前血人绒毛膜促性腺激素(β-HCG)值,子宫下段血流情况,妊娠囊直径及子宫肌壁厚度,分别采用甲氨蝶呤(MTX)+超声引导下清宫术(MTX+清宫术组)、子宫动脉栓塞术(UAE)+超声引导下清宫术(UAE+清宫术组)、开腹(腹腔镜下)CSP病灶切除+剖宫产瘢痕修补术[开腹(腹腔镜下)CSP切除+修补术组]、宫腹腔镜联合CSP病灶清除术(宫腹腔镜联合手术组)。比较4种手术方法术中出血量、住院天数、术后HCG下降至正常时间、阴道流血时间、月经复潮时间。结果MTX+清宫术手术时间短于其他3组,术中出血量多于其他3组,住院时间多于其他3组,差异有统计学意义(P<0.05)。MTX+清宫术组术后阴道流血时间和月经恢复时间均大于其他3组,差异有统计学意义(P<0.05)。不同时间段患者β-hCG水平均持续降低,MTX+清宫术组降低程度低于其他3组,差异有统计学意义(P<0.05)。结论4种手术治疗方法均安全有效,根据CSP患者的临床特点采取个性化的手术治疗方案是切实可行的。
Objective To explore an ideal surgical way for caesarean scar pregnancy(CSP)in the first trimester in order to provide basis for clinician to treat the disease in clinical practice.Methods The clinical data about 46 patients with CSP who were admitted and treated in our hospital from May 2012 to May 2016 were retrospectively analyzed.All the patients were diagnosed with CSP by transvaginal ultrasound using radiologic criteria.The patients were initially treated by different surgical managements accoring to CSP characteristic.These surgical managements included medical management combined with ultrasound-guided dilation and curettage(D&C)(group A),uterine artery embolization(UAE)combined with ultrasound-guided D&C(group B),laparoscopic/open excision and repair of the defect(group C)and hysteroscopy combined with laparoscopy excise(group D).The intraoperative blood loss,hospitalization time,β-HCG dropping to normal time,vaginal bleeding lasting days and the menstruation recovery time were observed and compared among the four groups.Results The operation time of MTX+deuterotomy was shorter than that of the other three groups,the intraoperative blood loss was higher than that of the other three groups,and the hospital stay was longer than that of the other three groups,the differences were statistically significant(P<0.05).Moreover the postoperative vaginal bleeding time and menstrual recovery time in MTX+deuterotomy group were longer than those in the other three groups(P<0.05).The levels of hCG of patients in different time points were continuously decreased,which in MTX+detoxification group were significantly lower than those in the other three groups(P<0.05).Conclusion The four kinds of surgical managements are effective and safe,and the individualized surgical therapeutic schedule according to clinical characteristics of patients with CSP is feasible.
作者
张志革
高敏
马琳
ZHANG Zhige;GAO Min;MA Lin(Department of Reproductive Medicine,The Third Hospital of Xingtai City,Hebei,Xingtai 054000,China)
出处
《河北医药》
CAS
2019年第15期2292-2295,共4页
Hebei Medical Journal
基金
邢台市科学技术研究与发展支撑计划项目(编号:2016ZC269)
关键词
剖宫产瘢痕妊娠
治疗
手术治疗
caesarean scar pregnancy
therapy
surgical treatment
