子宫瘢痕妊娠实用临床分型及应用价值探讨  

Practical clinical classification and its application in treatment of cesarean scar pregnancy

作　　者：康彦君 班艳丽[1] 张腾[1] 刘芬[1] 张贵宇[1] 张小磊[1] 崔保霞[1] Kang Yanjun;Ban Yanli;Zhang Teng(Department of Obstetrics and Gynecology,Qilu Hospital of Shandong University,Jinan 250012;Department of Obstetrics and Gynecology,Qingdao Women and Children's Hospital,Qingdao 266034)

机构地区：[1]山东大学齐鲁医院妇产科,济南250012 [2]青岛市妇女儿童医院,青岛266034

出　　处：《现代妇产科进展》2019年第10期731-735,共5页Progress in Obstetrics and Gynecology

基　　金：国家自然科学基金青年科学基金项目(No:81601315)

摘　　要：目的:分析按实用临床分型诊治剖宫产术后子宫瘢痕妊娠(CSP)的临床治疗效果。方法:选取2014年7月至2018年7月在齐鲁医院妇产科接受直接手术治疗的325例CSP患者,依据实用临床分型予以分型诊治,评价其临床治疗效果。结果:325例CSP患者,其中Ⅰ型127例,行超声监视下清宫术±宫腔镜手术;Ⅱa型56例,行超声监视下清宫术+宫腔镜手术;Ⅱb型36例,给予腹腔镜监视下清宫术+宫腔镜手术,必要时行瘢痕修补术,或经阴前穹窿切开瘢痕修补术;Ⅲ型106例,直接行腹腔镜手术或经阴前穹窿切开瘢痕修补术,若孕囊或包块直径>6cm,局部血流信号丰富或有动静脉瘘形成时,行开腹手术或子宫动脉栓塞后腹腔镜手术。年龄、剖宫产次数、距前次剖宫产时间各型之间比较无统计学差异(P>0.05)。孕龄、术前血β-HCG、病灶直径各型之间比较有统计学差异(P<0.05)。术中出血量、手术时间、住院时间、住院费用各型之间比较均有统计学差异(P<0.05)。各型按推荐的首选治疗方案治疗,成功率可达95.4%。无患者行子宫切除,无术后严重并发症发生。其中72.3%的患者的血β-HCG可在术后4周内恢复正常,91.5%的患者可在术后8周内月经来潮。结论:根据子宫瘢痕妊娠实用临床分型给予患者分型诊治,指导制定个体化的治疗方案,临床治疗效果可靠,具有较高的临床应用价值。Objective:To evaluate the effects of Practical Clinical Classification on treatment of cesarean scar pregnancy(CSP).Methods:Three hundred and twenty-five patients with CSP from July.2014 to July.2018 in the Qilu hospital were enrolled.All patients with CSP were classified based on Practical Clinical Classification and received individual treatment method.The clinical curative effects were analyzed.Results:Patients of CSP I(n=127)received suction curettage under ultrasound guidance combined with or without hysteroscopy.CSP IIa(n=56)received suction curettage under ultrasound guidance&hysteroscopy.CSP IIb patients(n=36)were treated with suction curettage&hysteroscopy under laparoscopic monitoring;CSP III(n=106)received laparotomy or laparoscopic surgery.Among these different types,there were no significant differences in age,the number of previous CS and internal from previous CS section(P>0.05).However,significant differences were observed in gestational age,serumβ-HCG,the maximum diameter of the lesion,intra-operative blood loss,time of surgery,hospital stay and expense(P<0.05).According to the suggested classification and treatment strategy,the overall success rate was 95.4%.No patients needed to accept hysterectomy and no severe surgery complications occurred.72.34%patients had a negative serumβ-HCG within four weeks after the surgery,and 91.49%patients resumed their menstrual cycles within eight weeks.Conclusion:This new Practical Clinical Classification is helpful to make an individual treatment strategy for CSP patients.It is a an effective method for CSP clinical treatment.

关 键 词：子宫瘢痕妊娠 临床分型 治疗 超声诊断 

分 类 号：R714.22[医药卫生—妇产科学]