选择性子宫动脉栓塞术联合宫腔镜手术治疗外生型剖宫产术后子宫瘢痕妊娠67例临床分析  

Clinical analysis on selective uterine artery embolization combined with hysteroscopic surgery for ;exogenous cesarean scar pregnancy in 67 cases

作　　者：王光伟[1] 刘晓菲[2] 王丹丹[1] 杨清[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,沈阳110004 [2]沈阳市妇婴医院妇产科

出　　处：《中华妇产科杂志》2015年第8期576-581,共6页Chinese Journal of Obstetrics and Gynecology

基　　金：辽宁省教育厅科学研究一般项目（L2012291）

摘　　要：目的：探讨子宫动脉栓塞术（UAE）联合宫腔镜手术治疗外生型剖宫产术后子宫瘢痕妊娠（CSP）的安全性及应用价值。方法回顾性分析2011年3月至2014年8月中国医科大学附属盛京医院诊治的接受选择性UAE联合宫腔镜手术治疗的67例外生型CSP患者的临床资料，其中35例子宫瘢痕处组织厚度〉3 mm（厚度〉3 mm组），32例瘢痕处组织厚度≤3 mm（厚度≤3 mm组），比较两组患者的手术时间、术中出血量、术后宫腔引流量、术后住院时间、β-hCG下降至正常时间、术后包块吸收时间等。结果厚度〉3 mm组患者宫腔镜手术均成功，其中1例因术后1个月复查彩超提示子宫瘢痕处仍有较大包块且β-hCG下降缓慢，于术后37 d行二次宫腔镜手术成功切除包块。厚度≤3 mm组患者宫腔镜手术中有3例转行腹腔镜或开腹手术，术后有7例患者接受了二次手术。厚度〉3 mm组患者宫腔镜手术中出血量为（97±41）ml，厚度≤3 mm组为（161±92）ml，两组比较，差异有统计学意义（P3 mm组宫腔镜手术时间、术后宫腔引流量、术后住院时间、血清β-hCG下降至正常时间、术后包块吸收时间分别为（36±9）min、（38±13）ml、（3.5±0.5）d、（26±5）d、（82±17）d，厚度≤3 mm组分别为（37±9）min、（42±16）ml、（4.0±0.7）d、（28±8）d、（88±15）d，分别比较，差异均无统计学意义（P〉0.05）。结论剖宫产术后子宫瘢痕处组织厚度≤3 mm时，应慎行宫腔镜手术。UAE联合宫腔镜手术治疗子宫瘢痕处组织厚度〉3 mm的外生型CSP安全、有一定的可行性，须根据患者情况严格把握适应证，并由经验丰富的宫腔镜医师完成手术。Objective To investigate the safety and feasibility of uterine arterial embolization （UAE） combined with hystersocpic excisionl of exogenous cesarean scar pregnancy （CSP）. Methods Totally 67 patients with exogenous CSP treated with selective UAE combined with hysterscopic surgery in Shengjing Hospital of China Medical University were analyzed retrospectively; 35 patients in Group A （thickness of the cesarean scar〉3 mm）, while 32 patients in Group B （thickness of the cesarean scar≤3 mm）. The following clinical parameters including operative time, intraoperative blood loss, quantity of postoperative uterine drainage, postoperative hospital days, the time for the mass absorption and the return ofβ-hCG to normal were compared. Results All hysterscopic procedures were successfully completed in Group A, and only one case underwent a second hysteroscopic excision due to the 1-month postoperative ultrasound examination indicating a mass located in the cesarean scar and a slow decline of β-hCG. Three cases of Group B were transformed to laparoscopic or laparotomy operation and 7 cases underwent a second？surgery. The volume of introperative blood loss was （97±41） ml in Group A and （161±92） ml in Group B, the difference was statistically significant （P0.05）. Conclusions For exogenous CSP, when the thickness of cesarean scar is ≤3 mm, whether or not undertaking UAE, it should be seen as contraindication of hysterscopic surgery. UAE combined with hysterscopic surgery for the treatment of exogeous CSP with the cesarean scar thickness〉3 mm is safe and feasible according to patients condition and should be performed by experienced hysteroscopist.

关 键 词：妊娠 异位 剖宫产术 宫腔镜检查 子宫动脉栓塞术 

分 类 号：R713.8[医药卫生—妇产科学]