髂内动脉阻断与子宫动脉栓塞治疗Ⅲ型子宫瘢痕部位妊娠的临床研究  

Treatment of typeⅢcesarean scars pregnancy by temporary occlusion of internal iliac artery or uterine artery embolization

作　　者：赵小清 张星光[1] 苏雪锋[1] 谢长远[1] 徐佳楠 邱玲玲 ZHAO Xiao-qing;ZHANG Xing-guang;SU Xue-feng;XIE Chang-yuan;XU Jia-nan;QIU Ling-ling(Department of Obstetrics&Gynecology,Yuyao People’s Hospital,Yuyao 315400)

机构地区：[1]余姚市人民医院妇产科,余姚315400

出　　处：《生殖医学杂志》2021年第7期918-922,共5页Journal of Reproductive Medicine

基　　金：宁波市医学科技计划项目(2019Y63)。

摘　　要：目的通过回顾性分析比较Ⅲ型子宫瘢痕部位妊娠(CSP)患者接受髂内动脉临时阻断或子宫动脉栓塞(UAE)预处理后行腹腔镜下子宫瘢痕病灶切除联合子宫修补术的临床疗效。方法选取2019年1月至2020年6月在余姚市人民医院诊断为Ⅲ型CSP的55例患者为研究对象,根据预处理方法的不同分为腹腔镜下髂内动脉临时阻断预处理组(A组,n=25)和UAE预处理组(B组,n=30),随后两组患者均行腹腔镜下子宫瘢痕病灶切除联合子宫修补术。比较两组术中出血量、手术时间、术后第1天和第5天β-HCG的下降百分比、术后β-HCG恢复正常的时间、手术住院总费用、住院天数、术后并发症发生率及术后第3个月排卵期子宫内膜厚度。结果与B组患者比较,A组患者的住院总费用、住院平均天数、术后β-HCG恢复正常时间减少,术后第3月排卵期子宫内膜厚度增厚,手术时间延长,而并发症发生率降低,差异均有统计学意义(P<0.05)。两组患者间术后第1天、第5天的β-HCG下降百分比、术中出血量差异均无统计学意义(P>0.05)。结论对Ⅲ型CSP进行腹腔镜下髂内动脉临时阻断术或UAE预处理,均能有效减少术中出血,确保手术的安全进行,但选择腹腔镜下髂内动脉临时阻断术,更能减少术后并发症的发生率、缩短住院时间、降低住院费用,对患者而言更经济、安全,值得临床应用及推广。Objective:To retrospectively analyze and compare the clinical effectiveness of laparoscopic cesarean scar lesion resection combined with uterine repair after pretreatment with temporary occlusion of internal iliac artery or uterine artery embolization(UAE)in patients with typeⅢcesarean scars pregnancy(CSP).Methods:Fifty-five patients who were initially diagnosed as typeⅢCSP in our hospital from January 2019 to June 2020 were selected as the study subjects.They were divided into the group A(n=25)and group B(n=30)according to different pretreatment methods.Twenty-five patients underwent laparoscopic temporary occlusion of internal iliac artery in the group A,and thirty patients underwent UAE in the group B.Then the patients in the two groups underwent laparoscopic cesarean scar resection combined with uterine repair.The intraoperative bleeding loss,the operation time,the percentage of decline ofβ-HCG on the first day and the fifth day after operation,the time forβ-HCG returning to normal after operation,the total hospitalization costs,the length of hospitalization,and the incidence of postoperative complications,the endometrial thickness at ovulation phase in the third month after operation of two groups were compared between the two groups.Results:Compared with the group B,the total hospitalization costs,average length of hospitalization and time forβ-HCG returning to normal after operation were significantly less in the group A,while the thickness of endometrium at ovulation phase in the third month after operation were significantly thicker and the operation time was significantly longer in the group A(all P<0.05).The incidence of postoperative complications in group A was significantly lower than the group B(P<0.05).There was no significant difference in the percentage of decline ofβ-HCG on the first day and the fifth day after operation and intraoperative blood loss between the two groups(P>0.05).Conclusions:Pretreatment with laparoscopic temporary occlusion of internal iliac artery or UAE for typeⅢC

关 键 词：腹腔镜髂内动脉临时阻断 子宫动脉栓塞 子宫瘢痕部位妊娠 

分 类 号：R714.22[医药卫生—妇产科学] R713.8[医药卫生—临床医学]