剖宫产瘢痕妊娠Ⅰ型的治疗方法研究  

Investigation of treatment protocol for cesarean scar pregnancy typeⅠ

作　　者：罗岚蓉[1] 李长东[1] Luo Lanrong;Li Changdong(Department of Reproductive Management,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院生殖调节科

出　　处：《首都医科大学学报》2019年第4期640-645,共6页Journal of Capital Medical University

基　　金：北京市科学技术委员会首都市民健康项目培育(Z131100006813034)~~

摘　　要：目的研究超声引导下清宫术和子宫动脉栓塞术后清宫术对剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)Ⅰ型的治疗特点。方法采用回顾性病例对照研究,研究组行超声引导下清宫术的52例,对照组为子宫动脉栓塞术(uterine artery embolization,UAE)后行超声引导下清宫术的26例。比较两组的治疗情况以及术后恢复情况。结果研究组治疗成功率为98%,对照组的治疗成功率为100%,手术时间以及手术出血量比较,差异无统计学意义(P>0.05)。研究组和对照组术后血人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)均下降满意,但术后1、7、14 d的血HCG下降比例,研究组均低于对照组,差异有统计学意义(P<0.05)。研究组与对照组术后血HCG降至正常的时间分别为(24.38±9.23) d vs (19.12±4.23) d,术后出血时间分别为(12.19±7.54) d vs (8.58±3.01) d,差异均有统计学意义(P<0.05)。研究组和对照组术后月经恢复的天数分别为(33.54±5.98) d vs (32.69±5.13) d,差异无统计学意义(P>0.05),但研究组30.8%月经减少显著低于对照组的61.5%。研究组36.5%术后第一次月经后超声检查发现子宫前壁下段有包块,显著高于对照组15.4%的比例,但是两组包块大小差异无统计学意义(P>0.05)。结论 CSPⅠ型应用超声引导下清宫术是有效而且安全的,但仍有出血风险,需要在有抢救设施的医疗机构进行,术前需全面评估病情,采取个体化治疗方案。术后需监测HCG至正常,如出现下降迟缓或停滞的情况,给与及时的治疗。Objective To compare ultrasound-guided uterine curettage and uterine curettage after uterine artery embolization(UAE)for cesarean scar pregnancy(CSP) typeⅠ treatment.Methods We performed retrospective case control study,fifty-two patients were given ultrasound-guided uterine curettage as the study group,26 patients were given UAE followed by ultrasound-guided uterine curettage as the control group.Ultrasound examination was used for the diagnosis.Results The treatment success rate of the study group was 98%,and that of the control group was 100%.There was no significant difference of operation time and bleeding volume between the two groups.The decrease of serum human chorionic gonadotropin(HCG) both of two group were satisfactory.But at 1 day,7 days and 14 days after operation,the decrease of serum HCG of study group was significantly slower than that of the control group.The time of blood HCG return to normal after operation of the study group and the control group was(24.38±9.23) days vs(19.12±4.23) days,and length of bleeding days after operation were(12.19±7.54) days and(8.58±3.01) days.The differences were significant.The days of menstrual recovery of the study group and the control group were(33.54±5.98) days and(32.69±5.13) days,respectively.There was no significant difference,but 30.8% menstrual reduction of the study group was significantly higher than 61.5% of the control group.In the study group,36.5% of abnormal mass in the lower anterior wall of uterine cavity can be found by ultrasound examination after the first menstruation was significantly higher than 15.4% that of the control group,but there was no difference of the size of the mass between the two groups.Conclusion CSP typeⅠcan be safely and effectively treated by ultrasound guided curettage.But surgery should be carried out in the hospital which are capable of salvage because bleeding risk of CSP is extremely high.For the treatment of CSP,monitoring the decrease of HCG is very important.Some patients showed slow descent of HCG in b

关 键 词：剖宫产瘢痕妊娠 清宫术 子宫动脉栓塞术 人绒毛膜促性腺激素 

分 类 号：R711[医药卫生—妇产科学]