子宫动脉栓塞术后经阴道与经宫腔镜治疗外生型剖宫产瘢痕妊娠临床疗效分析  

Analysis of the Clinical Efficacy of Transvaginal and Hysteroscopy after Uterine Artery Embolization in the Treatment of Cesarean Scar Pregnancy

作　　者：王远航[1] 韩宇宁[1] 刘佳[1] 芦维园 卢美松[1] 柳英兰[1] WANG Yuan-hang HAN Yu-ning LIU Jia LU Wei-yuan LU Mei-song LIU Ying-lan(Obstetrics and Gynecology Departrnent,First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, China)

机构地区：[1]哈尔滨医科大学附属第一医院妇产科,黑龙江哈尔滨150001

出　　处：《现代生物医学进展》2017年第6期1086-1089,共4页Progress in Modern Biomedicine

基　　金：黑龙江省自然科学基金重点项目(ZD201110);黑龙省教育厅课题(1252233)

摘　　要：目的:探讨子宫动脉栓塞术后经阴道与经宫腔镜治疗外生型剖宫产瘢痕妊娠(CSP)的临床疗效。方法:回顾性分析2013年10月至2015年5月哈尔滨医科大学附属第一医院收治的56例确诊为外生型CSP患者的临床资料,其中26例行子宫动脉栓塞术后经阴道切除外生型瘢痕妊娠病灶(经阴道手术组),30例行子宫动脉栓塞术后经宫腔镜切除外生型瘢痕妊娠病灶(经宫腔镜手术组)。比较两组患者的手术成功率、术中出血量、术后住院时间、住院费用、血HCG下降至正常时间及不良反应的发生情况等。结果经阴道手术组26例患者手术全部成功成功率为100%。经宫腔镜手术组30例患者中22例手术成功,8例因术中子宫穿孔改行腹腔镜或经腹外生型瘢痕妊娠病灶切除及子宫修补成功率为73.3%显著低于经阴道手术组差异有统计学意义(P<0.05)。经阴道手术组患者的术中出血量[(20.58±6.1)mL]及住院费用((8833.04±491.5)元)明显低于经宫腔镜手术组[(69.03±7.8)mL](P<0.001)、(14908.79±325.5)元(P<0.001)。结论:子宫动脉栓塞术后经阴道与经宫腔镜两种术式均能达到较理想的治疗效果;经阴道治疗外生型CSP可行性强于经宫腔镜手术更安全、有效,值得临床推广。Objective：To investigate the clinical effect of transvaginal and hysteroscopy on the type II cesarean scar pregnancy（CSP） after uterine artery embolization.Methods：The clinical data of 56 cases of patients diagnosed as type II CSP in First Affiliated Hospital of Harbin Medical University from October 2013 to May 2015 were retrospectively analyzed,including 26 cases underwent transvaginal operation after uterine artery embolization（Transvaginal Operation group） and 30 cases underwent hysteroscopy after uterine artery embolization（Hysteroscopy group）.The success rate of operation,intraoperation bleeding,postoperation hospital stay,hospitalization expenses,the time β-HCG decreased to normal and adverse reaction occurred in both groups were compared.Results：The operation of transvaginal group was completely successful in 26 patients,and the success rate was 100%.The operation of hysteroscopy group was successful in 22 cases,8 cases was converted to laparoscopic or abdominal operation excision and repair of uterine scar because of uterine perforation intraoperation,the success rate was 73.3%,which was significantly lower than the transvaginal group（P〈0.05）.The intraoperation bleeding and the hospitalization expenses in transvaginal operation group were（（20.58±6.1）ml）,（（8833.04±491.5）yuan）,which were both significantly lower than those（（69.03±7.8）mL）,（（14908.79±325.5）yuan） of the hysteroscopy group（P〈0.001）.Conclusions：Both transvaginal operation and hysteroscopic after uterine artery embolization could achieve the ideal therapeutic effect;the treatment of type II CSP by transvaginal operation was more safe and effective than hysteroscopy.It was worth clinical promotion.

关 键 词：剖宫产瘢痕妊娠 子宫动脉栓塞 宫腔镜手术 阴式手术 

分 类 号：R719[医药卫生—妇产科学]