阴式清除术对Ⅲ型剖宫产术后子宫瘢痕妊娠患者应激反应及再次妊娠影响  

Influences of transvaginal type Ⅲ cesarean scar pregnancy removal of patients on their stress response and reproductive function

作　　者：崔晓丽 赵洁 任菁晶 CUI Xiaoli;ZHAO Jie;REN Jingjing(Affiliated Hospital of Henan Medical College,The Second People's Hospital of Henan Province,Zhengzhou,Henan Province,450000)

机构地区：[1]河南省医学高等专科学校附属医院,河南省第二人民医院,郑州450000

出　　处：《中国计划生育学杂志》2022年第12期2699-2703,共5页Chinese Journal of Family Planning

摘　　要：目的:观察阴式清除术对Ⅲ型剖宫产术后子宫瘢痕妊娠(CSP)患者应激反应及生育功能的影响。方法:回顾性收集2019年1月-2021年6月本院收治的Ⅲ型CSP患者50例,依据治疗方式分组,采用甲氨蝶呤(MTX)+超声监视下清宫手术24例为对照组,采用阴式清除术26例为阴式组。比较两组手术情况、应激反应指标、性激素、并发症、随访1年正常妊娠率与复发率。结果:阴式组术中出血量(95.1±8.2 ml)少于对照组(186.7±49.1 ml),血β-人绒毛膜促性腺激素(β-hCG)复常用时(20.0±2.4d)短于对照组(36.0±5.8d),手术时长(43.9±8.5min)长于对照组(32.1±3.7min),住院时间(9.1±2.6d)短于对照组(14.9±2.4d);术后24h两组皮质醇(Cor)、去甲肾上腺素(NE)均较术前提高但阴式组低于对照组,术后两组睾酮(T)均较术前降低,卵泡刺激素、促黄体生成素、雌二醇均较术前提高,但阴式组变化幅度高于对照组(均P<0.05);阴式组并发症发生率(7.7%)低于对照组(37.5%),随访1年正常妊娠率(34.6%)高于对照组(8.3%),复发率(3.9%)低于对照组(25.0%)(均P<0.05)。结论:阴式清除术治疗Ⅲ型CSP虽手术时长略长,但具有术中出血量少、血β-hCG复常用时短、应激反应轻、并发症少、随访1年正常妊娠率高、复发率低等特点,利于患者生育功能保留、早日出院。Objective:To observe the influence of transvaginal type Ⅲ cesarean scar pregnancy(CSP)removal of patients on their stress response and reproductive function.Methods:A total of 50 patients with type Ⅲ CSP from January 2019 to June 2021 were collected retrospectively and were divided into two groups according to diffrent treatment methods.24 patients in group A were treated with methotrexate(MTX)combined curettage and evacuation monitored by ultrasound,and 26 patients in group B were treated with transvaginal curettage and evacuation.The operation status,the stress response,the levels of sex hormone,and the rates of complications,normal pregnancy,and recurrence of CSP during 1-year of follow-up of the patients were compared between the two groups.Results:The intraoperative blood loss(95.1±8.2 ml)of the patients in group B was significantly less than that(186.7±49.1 ml)of the patients in group A,and the time of the level of blood β-hCG return to normal(20.0±2.4d)of the patients in group B was significantly shorter than that(36.0±5.8d)of the patients in group A.The time of operation(43.9±8.5min)of the patients in group B was significantly longer than that(32.1±3.7min)of the patients in group A,and the hospital stay time(9.1±2.6d)of the patients in group B was significantly shorter than that(14.9±2.4d)of the patients in group A.The levels of cortisol(Cor)and norepinephrine(NE)of the patients in both groups at 24h after surgery had increased signifi-cantly,but which of the patients in group B were significantly lower than those of the patients in group A.The level of testosterone(T)of the patients in both groups after surgery had decreased significantly,and the levels of follicle stimulating hormone,luteinizing hormone,and estradiol of the patients in both groups had increased significantly after surgery,but the change range of which of the patients in group B were significantly more than those of the patients in group A(all P<0.05).The complication rate(7.7%)of the patients in group B was significantly lo

关 键 词：剖宫产术后子宫瘢痕妊娠 阴式清除术 手术指标 应激反应 术后妊娠 

分 类 号：R713.8[医药卫生—妇产科学]