腹主动脉球囊暂时阻断技术治疗剖宫产切口部妊娠的优势及安全性  

Advantages and Safety of Temporary Abdominal Aortic BalloonOcclusion in the Treatment of Cesarean Scar Pregnancy

作　　者：李丽鑫 郭瑞霞[1] 吴杰[1] 白晶[1] 刘媛媛 吴莹 LI Lixin;GUO Ruixia;WU Jie;BAI Jin;LIU Yuanyuan;WU Ying(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院妇产科,河南郑州450000

出　　处：《河南医学研究》2021年第18期3265-3269,共5页Henan Medical Research

基　　金：中原千人计划-中原名医(ZYQR201810107);中青年卫生健康科技创新人才(领军)(YXKC2020012)。

摘　　要：目的回顾性研究腹主动脉球囊暂时阻断技术治疗剖宫产切口部妊娠的优势及安全性。方法收集郑州大学第一附属医院2018年1月至2020年1月收治的剖宫产切口部妊娠患者70例,根据治疗方式分为对照组和观察组。其中观察组35例,于介入手术室行腹主动脉球囊预置术后,即时在宫腔镜或宫腹腔镜联合下行病灶清除术,术中行腹主动脉球囊暂时阻断技术,血管阻断期间清除妊娠组织;对照组35例,于介入手术室行子宫动脉栓塞术,1~3 d后在宫腔镜或宫腹腔镜联合下行病灶清除术。比较两组患者的手术时间、术中出血量、手术前后血红蛋白变化、手术前后血人绒毛膜促性腺激素(HCG)值变化、栓塞后综合征(主要包括术后发热、盆腔疼痛、恶心、呕吐等)及远期并发症(月经减少、闭经等)发生率、住院时间、介入手术费用。结果所有患者手术顺利,其中观察组18例接受宫腔镜手术,17例接受宫腹腔镜联合手术,对照组16例接受宫腔镜手术,19例接受宫腹腔镜联合手术。观察组与对照组宫腔镜手术时间、宫腹腔镜联合手术时间比较,差异无统计学意义(P>0.05)。两组术前、术后血红蛋白比较,差异无统计学意义(P>0.05),术中出血量比较,差异无统计学意义(P>0.05)。对照组术前血HCG值[42 220.77(15 664.75,60 400.75) IU·L^(-1)]高于术后[5 875.50(1 326.00,7 193.00)IU·L^(-1)](P<0.05);观察组术前血HCG值[37 287.24(16 955.25,58 376.25)IU·L^(-1)]高于术后[6 169.97(3 195.50,9 272.50)IU·L^(-1)](P<0.05)。两组患者术后血HCG值均较前下降,手术治疗有效。术后观察组有2例出现月经减少,对照组4例月经减少,16例栓塞后综合征,观察组并发症总发生率(5.71%)低于对照组(57.14%)(P<0.001)。观察组住院时间[(6.09±1.36)d]低于对照组[(7.10±1.83)d](P<0.05);观察组介入手术费用[(11 538.37±1 206.76)元]低于对照组[(15 668.24±1 791.50)元](P<0.05)。结论与子宫动脉栓塞Objective To retrospectively study the advantages and safety of temporary balloon occlusion of abdominal aorta in the treatment of cesarean scar pregnancy.Methods A total of 70 patients with cesarean scar pregnancy treated in the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2020 were selected,and divided into control group and observation group.Among them,35 patients in the observation group underwent focus debridement immediately under hysteroscopic or hysteroscopic combined with laparoscopic after balloon implantation of abdominal aorta in the interventional operating room,and temporary occlusion of abdominal aorta was performed during the operation,and pregnant tissue was removed during vascular occlusion.Thirty-five patients in the control group were treated with uterine artery embolization in the interventional operating room,and focus debridement was performed by hysteroscopy or hysteroscopy combined with laparoscopy 1-3 days later.The operation time,intraoperative blood loss,the change of hemoglobin before and after operation,the change of blood human chorionic gonadotropin(HCG)before and after operation,the incidence of post-embolization syndrome(including postoperative fever,pelvic pain,nausea and vomiting,etc.)and long-term complications(reduction of menstruation,amenorrhea,etc.),hospital stay and interventional operation cost were compared between the two groups.Results The operation of all the patients was smooth,including 18 patients in the observation group with hysteroscopic surgery,17 patients with hysteroscopic combined with laparoscopic surgery,16 patients with hysteroscopic surgery and 19 patients with hysteroscopic combined with laparoscopic surgery in the control group.There was no significant difference between the observation group and the control group in the time of hysteroscopic operation and hysteroscopic combined laparoscopic operation(P>0.05).There was no significant difference in hemoglobin between the two groups before and after operation(P>0.05),an

关 键 词：腹主动脉球囊 子宫动脉栓塞 剖宫产切口部妊娠 病灶清除术 

分 类 号：R714[医药卫生—妇产科学]