3种微创手术方法治疗子宫切口妊娠的探讨  

Clinical analysis of the treatment of the cesarean scar pregnancy

作　　者：艾小燕[1] 程玉芬[1] 李霞青 朱奕融[1] 郭小清[1] 

机构地区：[1]江西省妇幼保健院院妇科,南昌330006

出　　处：《江西医药》2016年第6期510-513,共4页Jiangxi Medical Journal

摘　　要：目的探讨3种子宫切口妊娠(cesarean scar pregnancy,CSP)保留生育功能的临床治疗方案子宫动脉灌注栓塞(uterus artery infusion embolization,UAIE)+清宫术(介入组)、经阴道子宫切口妊娠病灶清除术+子宫切口修补术(阴式组)和腹腔镜子宫切口妊娠病灶清除术+子宫切口修补术(腹腔镜组)的临床效果,探讨3种治疗方法在CSP治疗中的价值及意义。方法回顾分析2012年1月-2015年1月间205例患者,其中介入组109例,阴式组61例,腹腔镜组35例。分析比较患者的治愈率、术中出血量、手术时间、住院时间、住院费用、术后阴道出血时间、月经复潮时间、术后β-h CG下降情况,随访术后3个月月经来潮情况。结果介入组109例有95例治疗成功,成功率87.15%,14例因栓塞后清宫时大量阴道出血改行其他手术,阴式组及腹腔镜组治愈率为100%,P<0.001;阴式组手术时间及术中出血量最少,其次是介入组(P<0.001);阴式及腹腔镜组术后阴道出血时间及住院时间最短,术后血β-HCG下降最明显(P<0.001);住院费用介入组最高,腹腔镜手术组其次,阴式组最低;术后月经复潮时间:阴式组及腹腔镜组术后恢复最快,两组间无明显差异,介入组时间最长;术后3个月随访:阴式组及腹腔镜组术后月经无改变,介入组术后出现月经量减少者14例,发生率12.84%,其中闭经者7例,发生率为6.42%,经期延长者15例,发生率为13.76%,诊断为宫腔粘连者10例,发生率为9.17%。结论 3种治疗方案可用于治疗子宫切口妊娠,阴式手术具有微创、治愈率高、不良反应最小、可以修补子宫切口的优点,为CSP患者保留生育功能的最佳治疗方案;而难以经阴道手术的患者,腹腔镜为最佳治疗治疗方案;介入治疗为子宫切口妊娠并急性阴道大出血的首选治疗措施,但在治疗过程中子宫动脉栓塞术并多次刮宫对患者不良反应大、无法修补子宫切口,仍有再次CSP风险。Objective To analyze the clinical preserve fertility treatment options of the cesarean scar pregnancy：uterine arte-rial embolization （UAIE group）＋curettage,Transvaginal Cesarean Scar Pregnancy Debridement Surgery and myometrium neoplasty, （Vaginal surgery group）,Abdominal hysterectomy scar pregnancy debridement surgery and myometrium neoplasty （Laparoscopic surgery group）,discuss the value and significance of various therapies in the treatment of cuts pregnancy,and provide the basis for the clinical treatment of uterine incision pregnancy. Methods 205 cases from 2012 on Jan to 2015 on Jan,UAIE group of 109cases,61 cases of vaginal group,35cases in the laparoscopic group. To collect the four groups of patients with clinical data comprehensivly,Compare and analyse everything from the surgery bleeding,surgery time,Uterine distention fluid dosage,the hospi-talization time ancost,vaginal bleeding time,menstruation restored to normal time β-hCG restored to normal time,the success rate＆amp;nbsp;of treatment,and follow-up the change of the menstruation after three months of each treatment regimen. Results 109 csaes in UAIE group treatment successed 95 cases,the rate was 87.15%,14 cases was treated by other menthod because of acute vaginal bleeding during curettage. The vaginal and laparoscopic surgery group success rate was 100%,P〈0.001;The vaginal surgery group was minimal in bleeding loss and the operation time,followed by UAIE group （P〈0.001）,The postoperative vaginal bleeding time and hospitalization time of the vaginal and laparoscopic group was short,and the postoperative serum-HCG decreased most obvi-ously （P〈0.001）;The hospitalization expenses of UAIE was the highest,followed by laparoscopic operation group;The normal men-strual recovery time after operation：The postoperative recovery of operation treatment group （vaginal,laparoscopic group） was quick,there was no significant difference between the two groups,UAIE was longest recovery one （P〈0.001）;3 months follow-up a

关 键 词：子宫切口妊娠 治疗方法 妊娠病灶清除术 子宫切口修补术 

分 类 号：R714.2[医药卫生—妇产科学]