子宫动脉灌注化疗与宫腔镜下病灶电切术治疗瘢痕妊娠的疗效分析  

Therapeutic effects of uterine artery infusion chemotherapy combined with electrotomy under hysteroscope on uterine scar pregnancy

作　　者：张印星[1] 潘春燕[1] 陈小刚[1] 

机构地区：[1]湖北省鄂东医疗集团黄石市中心医院(湖北省理工学院附属医院)妇产科,435000

出　　处：《河北医药》2016年第13期1940-1942,共3页Hebei Medical Journal

基　　金：湖北省重点实验室开放基金项目(编号:SB201405)

摘　　要：目的探讨子宫动脉灌注栓塞化疗联合宫腔镜下病灶电切术治疗子宫瘢痕妊娠的临床效果。方法分析129例子宫切口瘢痕妊娠患者的治疗过程,采用甲氨蝶呤(MTX)静脉滴注并超声监视下行清宫术(对照组)62例,采用子宫动脉灌注栓塞化疗联合宫腔镜下病灶电切术治疗(研究组)67例,对比2组患者的疗效。结果研究组首次清宫出血量、阴道出血量、阴道出血持续时间、住院时间均显著低于对照组(P<0.05或<0.01),研究组住院费用高于对照组(P<0.01)。2组二次清宫率、大出血发生率、中转开腹率、子宫切除率比较,差异无统计学意义(P>0.05)。术后1周2组患者的β-HCG水平较术前显著降低(P<0.05),术后研究组β-HCG水平显著低于对照组(P<0.05)。研究组手术并发症率为19.40%低于对照组的38.71%(P<0.05)。结论子宫动脉灌注栓塞化疗联合宫腔镜下病灶电切术治疗子宫瘢痕妊娠具有出血量少,并发症率低、手术疗效可靠的优点。Objective To observe the therapeutic effects of uterine artery infusion chemotherapy combined with electrotomy under hysteroscope on uterine scar pregnancy. Methods The data about 129 patients with uterus incisional scar pregnancy were retrospectively analyzed in which 62 patients were treated by intravenous injection with methotrexate（ MTX）combined with uterus curettage under ultrasonic monitoring（ control group）,and the other 67 patients were treated by uterine artery infusion chemotherapy combined with electrotomy for lesions under hysteroscope（ trial group）. After treatment the therapeutic effects were observed and compared between two groups. Results The first bleeding volume after uterus curettage,vaginal bleeding time,vaginal bleeding duration,length of hospital stay in trial group were significantly lower than those in control group（ P 〈0. 05 or P 〈0. 01）,and the hospital costs in trial group were significantly higher than those in control group（ P 〈0. 05）. There were no significant differences in secondary uterine curettage rate,incidence of severe bleeding,laparotomy rate,uterus resection rate between two groups（ P 〈0. 05）. At 1 week after operation the levels of β-HCG in both groups were significantly decreased,as compared with those before operation（ P 〈0. 05）,however,the levels ofβ-HCG in trial group were significantly lower than those in control group（ P 〈0. 05）. The incidence of postoperative complications was19. 40% in trial group,which was significantly lower than that（ 38. 71%） in control group（ P 〈0. 05）. Conclusion The uterine artery infusion chemotherapy combined with electrotomy under hysteroscope in treatment of uterine scar pregnancy has many advantages including less bleeding volume,lower incidence of postoperative complications and reliable therapeutic effects.

关 键 词：子宫动脉灌注栓塞化疗 宫腔镜 电切术 子宫瘢痕 妊娠 

分 类 号：R714.2[医药卫生—妇产科学]