摘要
目的探究不同情况下剖宫产瘢痕妊娠采用宫腔镜下超声引导清宫术结合术前介入治疗的疗效情况。方法通过回顾性研究2017年3月1日-2021年4月30日某院计划生育病房收治的170例采用宫腔镜下超声引导清宫术的剖宫产瘢痕妊娠患者的手术疗效情况,按Ⅰ型、Ⅱ型活胎剖宫产瘢痕妊娠及稽留流产合并CSP术前是否进行子宫动脉栓塞治疗进行分组,比较每组患者的一般信息、孕囊的大小、术前血清β-HCG及术后治疗效果等。结果仅1例Ⅰ型活胎CSP术前行子宫动脉栓塞术治疗;对于Ⅱ型活胎CSP,栓塞组与非栓塞组在胎囊的大小及术前血清β-HCG的比较分别为2.61±0.84cm与2.08±0.76cm以及116730.91±78681.27mIU/ml与53625.95±43106.60mIU/ml,2组比较具有统计学意义,在年龄、停经时间、既往流产次数等方面无明显差异性;CSP合并稽留流产者中栓塞组血流丰富的比例及多次剖宫产史的比例明显高于非栓塞组,分别为38.46%与0%、30.77%与5.0%,二者比较具有统计学意义,而2组胎囊大小、术前血清β-HCG、年龄、停经时间、既往流产次数等方面的比较无明显差异性。结论对于多数Ⅰ型活胎CSP无需行UAE可直接行超声引导清宫术,但需结合子宫瘢痕处血流及孕周情况进行分析;对于Ⅱ型活胎CSP,术前是否行UAE,治疗取决于胎囊的大小及术前血清β-HCG水平:胎囊平均直径小于2.5cm且术前血清HCG小于60000mIU/ml者,术前未行UAE而直接行宫腔镜下超声引导清宫术相对安全;对于CSP合并稽留流产者,胎囊的大小及术前血清β-HCG不是决定是否进行术前介入治疗的决定因素,需结合子宫瘢痕处肌层薄厚及周围血流的情况进一步分析。
Objectives This study aims to investigate the efficacy of hysteroscopic ultrasound-guided hysterectomy combined with preoperative interventional treatment in cesarean scar pregnancy under different circumstances.Methods This study retrospectively explored the surgical efficacy of 170 cases of cesarean scar pregnancy patients who underwent hysteroscopic ultrasound-guided evacuation in the family planning ward of a hospital from March 1,2017 to April 30,2021.All cases were categorized based on type Ⅰ and typeⅡlive fetal CSP and whether uterine artery embolization was performed before the operation of missed abortion combined with CSP.The general information of each group of patients,the size of the gestational sac,the preoperative serumβ-HCG and the postoperative treatment effect were compared.Results In this study,only one case of type Ⅰ live fetus CSP was treated with UAE before surgery.For typeⅡlive fetus CSP,the size of the fetal sac and the preoperative serumβ-HCG in the embolized group and the non-embolic group were 2.61±0.84cm vs 2.08±0.76cm,116730.91±78681.269mIU/ml vs 53625.95±43106.595mIU/ml,respectively.The comparisons between the two groups were statistically significant.There is no significant difference in age,time of menopause,number of previous miscarriages,etc.Among the cases of CSP combined with missed abortion,the proportion of rich blood flow and the history of multiple cesarean sections in the embolization group were significantly higher than those in the non-embolization group,which were 38.46%vs 0%and 30.77%vs 5.0%,respectively.The comparison was statistically significant.However,there was no significant difference in the average diameter of fetal sac and preoperative serumβ-HCG,age,time of menopause,number of previous miscarriages,etc.between the two groups.Conclusions Most type Ⅰ CSPs with live fetuses can treated by ultrasound-guided uterine evacuation directly instead of using the preoperative interventional therapy.But this circumstance also needs to be analyzed in conju
作者
崔鑫
张凯
Cui Xin;Zhang Kai(Department of Obstetrics and Gynecology,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing,100050;不详)
出处
《中国病案》
2022年第9期101-104,共4页
Chinese Medical Record
关键词
剖宫产瘢痕妊娠
超声引导清宫术
子宫动脉栓塞术
Cesarean scar pregnancy
Ultrasound-Guided Evacuation
Uterine arterial embolization
