不同术式治疗早孕期剖宫产术后子宫瘢痕妊娠各分型的效果分析  

Compare to the difference of different surgical treatments in curing the early cesarean scars pregnancy

作　　者：罗娟 韩克[1] 汤晓秋[1] 周怀君[1] LUO Juan;HAN Ke;TANG Xiao-qiu;ZHOU Huai-jun(Department of Obstetrics and Gynecology,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京大学医学院附属鼓楼医院妇产科,南京210008

出　　处：《东南国防医药》2018年第6期586-591,共6页Military Medical Journal of Southeast China

摘　　要：目的探讨早孕期剖宫产术后子宫瘢痕妊娠(CSP)各临床分型的手术治疗效果。方法选择2013年1月至2018年2月确诊为CSP的患者183例为观察对象,并将其分为Ⅰ型组55例、Ⅱ型组77例、Ⅲ型组26例、包块型组25例。对各分型中行腹腔镜或B超监视下清宫术、腹腔镜或B超监视下清宫术+水囊填塞术、腹腔镜下清除胚胎联合清宫术+子宫瘢痕切除修补术及子宫动脉介入栓塞术后清宫术4种手术方式的治疗效果进行分析,比较各手术治疗CSP的手术时间、术中出血量、住院时间、术后阴道流血时间、术后月经来潮时间以及术后血β-HCG降至正常时间。结果腹腔镜或B超监视下清宫术、腹腔镜或B超监视下清宫术+水囊填塞治疗Ⅰ型、Ⅱ型、Ⅲ型及包块型CSP的术中出血量呈上升趋势;而腹腔镜下清除胚胎联合清宫术+子宫瘢痕切除修补术及子宫动脉介入栓塞术后清宫术治疗各型CSP的术中出血量无明显差异。上述4种手术方式在治疗Ⅰ型、Ⅱ型CSP的手术时间、住院时间、术后阴道流血时间、术后月经来潮时间以及术后血β-HCG降至正常时间比较差异无统计学意义(P>0.05);而腹腔镜下清除胚胎联合清宫术+子宫瘢痕切除修补术治疗Ⅲ型、包块型CSP患者,术后阴道流血时间、术后月经来潮时间、术后血β-HCG降至正常时间均短于上述其他3种手术方法(P<0.05)。结论孕早期CSP的手术治疗方案可根据临床分型选择合理的有效治疗措施,腹腔镜或B超监视下清宫术适用于Ⅰ型、Ⅱ型CSP患者;腹腔镜下清除胚胎联合清宫术+子宫瘢痕切除修补术更适用于Ⅲ型、包块型CSP患者。Objective Cesarean scars pregnancy(CSP)may seriously threaten the reproductive health.In this essay,we investigated the difference of different surgical treatments in curing the early CSP. Methods One hundred and eighty-three patients diagnosed with CSP during January 2013 to February 2018 were analyzed,which divided into typeⅠgroup(55 cases),typeⅡgroup(77 cases),typeⅢgroup(26 cases),and mass type group(25 cases).We evaluated the effect of suction curettage under surveillance of laparoscopy or ultrasound,suction curettage under surveillance of laparoscopy or ultrasound+water pocket application,suction curettage after uterine artery embolization and combination of embryos clearing under laparoscopic and suction curettage+uterine scar resection and repair in all clinical types of CSP.The operation time,intraoperative blood loss,hospital stays,postoperative vaginal bleeding time,postoperative menstrual time and the returning normal time of bloodβ-HCG were analyzed to evaluate the outcomes of different surgical treatments. Results The amount of bleeding was on the rise during the operation among suction curettage under surveillance of laparoscopy or ultrasound,suction curettage under surveillance of laparoscopy or ultrasound+water pocket application curing typeⅠ,typeⅡ,typeⅢand mass type.The amount of bleeding among suction curettage after uterine artery embolization and combination of embryos clearing under laparoscopic and suction curettage+uterine scar resection and repair in all clinical types of CSP was shown nonsignificant difference.There was also no difference of the operation time,intraoperative blood loss,hospital stays,postoperative vaginal bleeding time,postoperative menstrual time and the returning normal time of bloodβ-HCG among the four kinds of surgical ways in the treatment of typeⅠorⅡCSP(P>0.05).It was recommended to perform the combination of embryos clearing under laparoscopic and suction curettage+uterine scar resection and repair in curing typeⅢor mass cesarean scars pregnanc

关 键 词：剖宫产术后子宫瘢痕妊娠 瘢痕妊娠分型 手术治疗 

分 类 号：R714.22[医药卫生—妇产科学]