宫腔镜手术与子宫动脉栓塞治疗剖宫产瘢痕妊娠的临床疗效比较  

Comparation of the treatment effects of hysteroscopic operation and uterine arteries embolism on cesarean scar pregnancy

作　　者：陈为 黄立萍[2] 车坤兰 CHEN Wei;Huang Liping;CHE Kunlan(Department of Gynecology,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260 China;Health care of Guangdong international travel,Guangzhou 510010,China)

机构地区：[1]广州医科大学附属第二医院妇科,广州510260 [2]广东国际旅行卫生保健中心,广州510010

出　　处：《实用医学杂志》2018年第14期2333-2335,共3页The Journal of Practical Medicine

基　　金：广东省自然科学基金(编号:2017A030313656)

摘　　要：目的通过与子宫动脉栓塞术(UAE)治疗剖宫产瘢痕妊娠(CSP)的比较,探讨宫腔镜手术的安全性及有效性。方法回顾2016年1月至2017年12月我科收治的CSP39例。宫腔镜组23例,术前48 h注射MTX 50 mg,术中配合垂体后叶素宫颈注射行清宫术,观察术后妊娠组织残留情况,如有残留同时予以电切。4例因孕囊距浆肌层<3 mm或向膀胱凸起,术中予腹腔镜监护。UAE组16例,UAE术后24-48 h行超声监护下清宫术。比较两组术中出血量,术后血βh CG下降幅度及疼痛感、住院时间及费用等。结果 1.宫腔镜组术后疼痛感明显减轻,无需术后镇痛;住院费用明显下降,两组统计学上有显著性差异;术中出血量、住院天数无统计学差异。2.宫腔镜组中14例有瘢痕憩室或缺陷存在,其中11例清宫术后发现憩室或缺陷处有绒毛组织残留。结论宫腔镜手术治疗CSP安全、有效,同时通过电切可避免清宫不全的发生。Objective To evaluate the safety and validity of the hysteroscopic operation on cesarean scar pregnancy(CSP)in comparation with uterine arteries embolism(UAE).Method Thirty-nine CSP cases were retrospectivly analyzed from Jan 2016 to Dec 2017 in our department.Twenty-three cases received hysteroscopic operations combined with the cervical injection of pituitrin and the suction curettage.If the residual gestational tissue was found after curettage,electrotomy will be given.Four of them were monitored under laparoscopy because the scar muscular layer was<3 mm or the gestational sac sticked to the bladder.While the other 16 cases received UAE,followed by the curettage with ultrasound monitoring within 24-48 hours later.The bleeding volum,βhCG falling range,the aching feeling,hospital staying length and the medical fee were evaluated between the two groups.Results 1.The aching feeling was extremely lighter in hysteroscopy group without the analgesic after operation and the medical fee was less than UAE group(P<0.05).2.Cesarean scar defect(CSD)such as diverticulum was detected in 14 cases received hysteroscopy,and the residual gestational tissue was remained in 11 cases with CSD.Conculsion Hysteroscopic operation combined with the cervical injection of pituitrin and the suction curettage is an ideal treatment method of CSP.Incomplete abortion could be avoided by hysteroscopic operation during the treatment of CSP.

关 键 词：剖宫产瘢痕妊娠 宫腔镜 子宫动脉栓塞 

分 类 号：R713.8[医药卫生—妇产科学]