腹腔镜下子宫动脉临时阻断联合病灶切除术治疗外生型剖宫产瘢痕妊娠的临床研究  

Clinical study of laparoscopic temporary uterine artery occlusion combined with focal excision in the treatment of exogenous cesarean scar pregnancy

作　　者：彭秀秀 熊员焕[1] 徐萍 林燕 陈丽珍 谢文阳[5] PENG Xiuxiu;XIONG Yuanhuan;XU Ping;LIN Yan;CHEN Lizhen;XIE Wenyang(Department of Gynecology,Jiangxi Provincial People’s Hospital,the First Affiliated Hospital of Nanchang MedicalCollege,Jiangxi,Nanchang 330006,China;Department of Obstetrics and Gynecology,Affiliated Hospital ofShangrao Health School,Jiangxi,Shangrao 334099,China;Department of Obstetrics and Gynecology,ShangraoPeople’s Hospital,Jiangxi,Shangrao 334099,China;Department of Obstetrics and Gynecology,Jingdezhen FirstPeople’s Hospital,Jiangxi,Jingdezhen 333000,China;Department of Gynecology,Jiujiang Maternal and ChildHealth Hospital,Jiangxi,Jiujiang 332000,China)

机构地区：[1]江西省人民医院南昌医学院第一附属医院妇科,江西南昌330006 [2]上饶卫校附属医院妇产科,江西上饶334099 [3]江西省上饶市人民医院妇产科,江西上饶334099 [4]江西省景德镇市第一人民医院妇产科,江西景德镇333000 [5]江西省九江市妇幼保健院妇科,江西九江332000

出　　处：《中国医药科学》2023年第5期7-11,共5页China Medicine And Pharmacy

基　　金：江西省卫生计生委科技计划课题(20195049)。

摘　　要：目的 分析腹腔镜下子宫动脉临时阻断联合病灶切除术在外生型剖宫产瘢痕妊娠(CSP)的临床应用价值。方法 收集江西省人民医院、上饶卫校附属医院、上饶市人民医院、景德镇第一人民医院、九江市妇幼保健院2016年7月至2018年6月收治的外生型CSP患者资料(104例)。根据手术方式不同,将其分为腹腔镜下子宫动脉临时阻断联合病灶切除术组(A组),腹腔镜下病灶切除术组(B组),子宫动脉栓塞联合腹腔镜下病灶切除术组(C组)。组间疗效的评价指标包括手术时间、术中出血量及围手术期输血率、术后疼痛评分、血β-人绒毛膜促性腺激素(β-HCG)恢复正常时间、住院时间、术后1~2年间的妊娠情况。结果 三组血β-HCG恢复正常时间及住院时间差异无统计学意义(P> 0.05);A组的手术时间长于C组(P <0.05),但与B组差异无统计学意义(P> 0.05);A组的术中出血量及围手术期输血率低于B组(P <0.05),与C组差异无统计学意义(P> 0.05);A组的术后24及48 h疼痛VAS评分与B组差异无统计学意义(P> 0.05),但低于C组(P <0.05)。A组的妊娠率和活产率高于C组,差异有统计学意义(P <0.05),与B组差异无统计学意义(P> 0.05)。结论 腹腔镜子宫动脉临时阻断联合病灶切除术能有效降低CSP患者的出血风险、减轻患者术后疼痛。对于有再生育期望的女性,也能极大程度保护其生育功能,具有临床应用价值。Objective To analyze the clinical application value of temporary uterine artery occlusion combined with focal resection in ectopic cesarean section scar pregnancy(CSP).Methods Data of 104 patients with exogenous CSP admitted to Jiangxi Provincial People’s Hospital,Affiliated Hospital of Shangrao Health School,Shangrao People’s Hospital,Jingdezhen First People’s Hospital,Jiujiang Maternal and Child Health Hospital from July 2016 to June 2018 were collected.According to different surgical methods,they were divided into the laparoscopic temporary blockage of uterine artery combined with focal resection group(group A),laparoscopic focus resection group(group B),Uterine artery embolization combined with laparoscopic focus resection group(group C).Intergroup efficacy was evaluated by operative time,intraoperative blood loss and perioperative blood transfusion rate,postoperative pain score,time to return to normal bloodβ-HCG,length of hospital stay,and pregnancy status 1-2 years after surgery.Results There were no significant differences in the recovery time of bloodβ-HCG and the length of hospitalization among the three groups(P>0.05).The operation time of group A was longer than that of group C(P<0.05),but there was no significant difference between group A and group B(P>0.05).The intraoperative blood loss and perioperative blood transfusion rate in group A were lower than those in group B(P<0.05),and similar to those in group C(P>0.05).The VAS scores at 24 and 48 hours after surgery in group A were similar to those in group B(P>0.05)but lower than those in group C(P<0.05).The pregnancy rate and live birth rate of group A were higher than those of group C,the difference was statistically significant(P<0.05),but there was no statistically significant difference between group A and group B(P>0.05).Conclusion Laparoscopic temporary uterine artery occlusion combined with focal resection can effectively reduce the risk of bleeding and relieve postoperative pain in patients with CSP.For women who have the expectatio

关 键 词：剖宫产瘢痕妊娠 子宫动脉临时阻断 子宫动脉栓塞 病灶清除 

分 类 号：R713.8[医药卫生—妇产科学]