不同方式治疗225例Ⅱ型剖宫产瘢痕妊娠的临床病例分析  

Clinical analysis of 225 cases of typeⅡcesarean scar pregnancy treated by different methods

作　　者：胡乔飞[1] 李长东[1] 陈素文[1] 罗岚蓉[1] 张晓峰[2] 李坚[1] HU Qiaofei;LI Changdong;CHEN Suwen;LUO Lanrong;ZHANG Xiaofeng;LI Jian(Department of Reproductive Regulation,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100006,P.R.China;Department of Radiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100006,P.R.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,北京100006 [2]首都医科大学附属北京妇产医院放射科,北京100006

出　　处：《中国计划生育和妇产科》2020年第8期19-23,共5页Chinese Journal of Family Planning & Gynecotokology

基　　金：北京市医院管理局临床医学发展专项经费资助(项目编号:ZYLX201830)

摘　　要：目的探讨不同方式治疗Ⅱ型剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)的临床疗效。方法回顾性分析2016年1月至2017年12月在北京妇产医院生殖调节科手术治疗的225例Ⅱ型CSP的临床资料,其中114例行宫腔镜手术(非介入球囊组),72例行宫腔镜手术联合子宫动脉栓塞术(uterine artery embolization,UAE)(介入组),39例行宫腔镜手术联合宫腔球囊压迫(球囊组),分析不同治疗方式的临床疗效。结果①3组在年龄、孕次、剖宫产次数、流产次数、距离前次剖宫产时间、孕囊处最薄肌层厚度及是否保胎方面比较,差异无统计学意义(P>0.05);但介入组在停经天数、孕囊大小、术前血人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)值、宫腔积血率及活胎率方面高于非介入球囊组(P<0.05),术前血hCG值及孕囊大小在3组间差异有统计学意义(P<0.05)。②介入组手术时间短且术后血hCG下降快,但术后血hCG恢复正常时间、月经恢复时间及住院时间长,差异均有统计学意义(P<0.05)。结论Ⅱ型CSP患者行宫腔镜手术,部分联合宫腔球囊压迫或UAE治疗疗效确切。大部分未予UAE治疗的Ⅱ型CSP患者术后恢复快。对有多个高危因素如停经天数长、孕囊较大、术前血hCG值高、活胎且有宫腔积血的Ⅱ型CSP患者优先考虑UAE。Objective To discuss the clinical treatment effect of type Ⅱ cesarean scar pregnancy treated by different methods.Methods The clinical data of 225 cases of type Ⅱ cesarean scar pregnancy which were treated by surgery in the department of reproductive regulation of Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2016 to December 2017 were retrospectively analyzed. Among them, 114 cases were treated with hysteroscopy(non-interventional group),72 cases were treated with hysteroscopy and uterine artery embolization(UAE group), and 39 cases were treated with hysteroscopy and uterine balloon compression,analyzed the clinital efficacy of different treatment methods(intrauterine balloon group).Results ① There were no statistically significant differences among the three groups in age, number of pregnancies, number of cesarean section, number of miscarriages, time from previous cesarean section, thickness of the thinnest muscle layer at the gestational sac(P>0.05).The number of menopause days, gestational sac size, preoperative blood human chorionic gonadotropin(hCG) value, intrauterine hemorrhage rate and live birth rate were significantly higher in the UAE group than in the non-interventional group(P<0.05).There were statistically significant differences in preoperative blood hCG value and the size of the gestational sac among the three groups(P<0.05).② The UAE group had short operation time,and rapid blood hCG decline,but the time of blood hCG decline to normal, menstrual recovery time and hospitalization time were longer,the differences were statistically significant(P<0.05).Conclusion The clinical effect of type Ⅱ CSP patients underwent hysteroscopic surgery, some combined with intrauterine balloon compression or UAE is definite. Most patients with type Ⅱ CSP who have not been treated with UAE recovered quickly. UAE is a priority for patients with type Ⅱ CSP who have multiple high-risk factors, such as long menopause days, large gestational sacs, high hCG values befor

关 键 词：剖宫产瘢痕妊娠 宫腔镜手术 治疗方式 

分 类 号：R713.8[医药卫生—妇产科学]