不同手术方式治疗子宫瘢痕妊娠的效果评价  

Effect of different surgical procedures in treating uterine scar pregnancy

作　　者：邱育红[1] 孙蓓[1] 

机构地区：[1]陕西中医药大学第二附属医院妇二科,陕西省咸阳市712000

出　　处：《中国医药》2016年第1期114-119,共6页China Medicine

摘　　要：目的探讨不同手术方式治疗子宫瘢痕妊娠的效果，指导临床选择适合的手术方式。方法回顾性分析2010年6月至2015年1月陕西中医药大学第二附属医院收治的子宫瘢痕妊娠行手术治疗的患者45例，根据手术方式不同分为清宫组（8例，在彩色多普勒超声引导下行清宫术）、宫腔镜组（13例，行子宫动脉栓塞＋宫腔镜下病灶切除术）、腹腔镜组（14例，行腹腔镜下病灶切除术）和经阴手术组（10例，经阴道行病灶切除术）。记录每组治疗前血β-人绒毛膜促性腺激素（β-HCG）水平、孕囊直径及种植部位距浆膜面的厚度；治疗后血β-HCG水平恢复至正常所需时间、住院时间、手术时间及出血情况；计算各组治愈率，评价其治疗效果。结果术前，腹腔镜组孕囊直径、血β-HCG水平均高于清宫组、宫腔镜组和经阴手术组［（46±15）mm比（15±4）、（16±6）、（17±5）mm，（7 367±3 148）IU/L比（1 210±546）、（6 276±1 254）、（6 412±1 317）IU/L］，清宫组种植部位距离浆膜面厚度明显高于宫腔镜组、腹腔镜组和经阴手术组［（6.4±3.5）mm比（2.5±2.1）、（2.4±2.2）、（2.3±2.0）mm］，差异均有统计学意义（均P＜0.05）。术中，清宫组中有2例因出血量大中转开腹治疗，宫腔镜组1例行开腹治疗，腹腔镜组手术顺利，经阴手术组有1例前腹壁粘连，在腹腔镜下解除粘连后继续行经阴道手术。术后，4组患者出血量比较差异有统计学意义（P＜0.05），其中清宫组最多［（307±218）ml］，腹腔镜组最少［（36±22）ml］，而宫腔镜组和经阴手术组比较［（152±74）ml比（161±105）ml］,差异无统计学意义（P＞0.05）；清宫组手术时间明显少于宫腔镜组、腹腔镜组和经阴手术组［（18±5）min比（93±24）、（95±26）、（62±10）min］，差异有统计学意义（P＜0.05），而宫腔镜组和腹腔镜组比较差�ObjectiveTo investigate the effect of different surgical procedures in treating uterine scar pregnancy （CSP）. MethodsTotally 45 CSP patients underwent operation from June 2010 to January 2015 were retrospectively analyzed. Eight patients underwent dilatation and curettage guided by color Doppler ultrasound （curettage group）, 13 patients underwent uterine artery embolization combined with hysteroscopic resection of the lesion （hysteroscopy group）, 14 patients underwent laparoscopic resection of the lesion （laparoscopic group）, 10 patients underwent transvaginal resection of the lesion （transvaginal group）. The level of β-human chorionic gonadotropin （β-HCG）, diameter of the gestational sac, thickness from planting site to film were measured; the time needed for β-HCG returning to normal, hospitalization duration, operation duration and postoperative bleeding were recorded; the curative rate was calculated. ResultsThe gestational sac diameter and serum-HCG level in laparoscopic group were significantly higher than those in curettage group, hysteroscopy group and transvaginal group [（46±15） mm vs （15±4）, （16±6）, （17±5） mm; （7 367±3 148） IU/L vs （1 210±546）, （6 276±1 254）, （6 412±1 317） IU/L] （P〈0.05）; the thickness from planting site to film in curettage group was significantly thicker than those in hysteroscopy group, laparoscopic group and transvaginal group [（6.4±3.5） mm vs （2.5±2.1）, （2.4±2.2）, （2.3±2.0） mm] （P〈0.05）. During the operation, 2 cases in curettage group were conversed to laparotomy because of large amount of bleeding; 1 case in hysteroscopy group were conversed to laparotomy; 1 case in transvaginal group underwent laparotomy for lysis of adhesion with anterior abdominal wall, then the transvaginal resection was continued. The postoperative bleeding volume were significantly different among groups, which was the most in curettage group [（307±218） ml] and the least in laparoscopic group [（36±22�

关 键 词：子宫瘢痕妊娠 手术 疗效 

分 类 号：R713[医药卫生—妇产科学]