摘要
目的:探讨不同术式对剖宫产瘢痕部位妊娠(CSP)患者治疗效果及预后的影响。方法:选择2021年2月1日至2022年1月31日于井冈山大学附属医院妇产科收治的Ⅱ型或Ⅲ型CSP患者90例为研究对象,按照纳入、排除标准及入院治疗的时间顺序依次入组,根据治疗方式依次纳入A组30例、B组30例和C组30例。A组接受腹腔镜下子宫动脉结扎术(UAL)+子宫瘢痕妊娠病灶切除术(FER)+子宫瘢痕修补术(UCR),B组接受子宫动脉栓塞术(UAE)+超声监测下宫腔镜FER,C组接受腹腔镜下FER+UCR。比较3组的术中、术后情况及随访复发性CSP(RCSP)的发生率和再妊娠率。结果:①A组、B组的术中出血量、术后宫腔引流量、术后疼痛视觉模拟(VAS)评分低于C组,而手术时间、住院费用高于C组,以上差异均有统计学意义(P<0.05);A组手术时间、住院费用低于B组(P<0.05)。②A组、B组术后阴道停止流血时间、月经恢复时间和血β-人绒毛膜促性腺激素(β-hCG)恢复时间短于C组(P<0.05)。③3组术后并发症(盆腔粘连、感染、术后大出血及下腹疼痛)的发生率差异均无统计学意义(P>0.05)。④术后平均随访时间17.60±5.61个月,A组、C组RCSP发生率低于B组(P<0.05)。A组、B组、C组再次妊娠率分别为82.14%(23/28)、77.78%(21/27)、81.48%(22/27),差异无统计学意义(P>0.05)。结论:腹腔镜下UAL+FER+UCR和UAE+超声监测下宫腔镜FER能减少术中出血量,促进术后康复,只是手术时间延长、住院费用较高;采用UCR治疗后RCSP发生率更低,临床应结合Ⅱ型、Ⅲ型CSP患者具体病情、经济条件和保留生育功能需求等进行综合评估并制定个体化的治疗方案。
Objective:To explore the effects of different surgical methods on the treatment outcomes and prognosis in patients with caesarean section scar pregnancy(CSP).Methods:A total of 90 patients with typeⅡorⅢCSP admitted to Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University between February 1,2021 and February 1,2022 were selected as the study subjects.They were enrolled in order of inclusion,exclusion criteria,and admission treatment time.According to different treatment methods,they were divided into group A(30 cases),group B(30 cases)and group C(30 cases).The group A underwent laparoscopic uterine artery ligation(UAL)+focus excision and repair of scar pregnancy(FER)+uterine cicatricial repair(UCR),group B underwent uterine artery embolization(UAE)+hysteroscopic FER under ultrasonic monitoring,and group C underwent laparoscopic FER+UCR.The intraoperative and postoperative conditions,as well as the incidence of recurrent CSP(RCSP)rate and repregnancy rate during follow-up in the three groups were compared.Results:①The intraoperative blood loss,postoperative uterine drainage volume and postoperative VAS score in groups A and B were lower than those in group C,while the operation time and hospitalization cost were higher than those in group C(P<0.05).The operation time and hospitalization cost in group A were lower than those in group B(P<0.05).②The postoperative vaginal hemostasis time,menstrual recovery time and recovery time of serumβ-human chorionic gonadotropin(β-HCG)in groups A and B were shorter than those in group C(P<0.05).③There was no statistically significant difference in the incidence of postoperative complications such as adhesion,infection,severe bleeding,and lower abdominal pain among the three groups(P>0.05).④The mean follow-up time after surgery was(17.60±5.61)months,and the incidence of RCSP in group A and group C was lower than that in group B(P<0.05).The rate of repregnancy in group A,group B and group C was 82.14%(23/28),77.78%(21/27)and 81.48%(22
作者
曾克非
夏婷婷
吴小兰
雷详华
ZENG Kefei;XIA Tingting;WU Xiaolan(Department of Obstetrics and Gynecology,Affiliated Hospital of Jinggangshan University Ji′an Jiangxi 343000,China;Department of Reproductive Medicine,Affiliated Hospital of Jinggangshan University Ji′an Jiangxi 343000,China)
出处
《实用妇产科杂志》
CAS
CSCD
北大核心
2024年第9期751-755,共5页
Journal of Practical Obstetrics and Gynecology
基金
江西省卫生健康委科技计划项目(编号:202310857)。
关键词
剖宫产瘢痕部位妊娠
瘢痕妊娠病灶切除术
子宫瘢痕修补术
子宫动脉结扎术
子宫动脉栓塞术
Caesarean section scar pregnancy
Resection of cicatricial pregnancy lesions
Uterine scar repair
Uterine artery ligation
uterine artery embolization
