腹腔镜下临时动脉阻断术治疗Ⅱ型及Ⅲ型剖宫产子宫瘢痕处妊娠近远期临床效果  

Short-term and long-term clinical effects of laparoscopic uterine artery temporary occlusion assisted treatment of typeⅡorⅢcesarean scar pregnancy

作　　者：王蕾[1] 陈友国[1] 周洋 Wang Lei;Chen Youguo;Zhou Yang(The First Affiliated Hospital of Soochow University,Suzhou 215006)

机构地区：[1]苏州大学附属第一医院,苏州215006

出　　处：《现代妇产科进展》2023年第4期264-267,272,共5页Progress in Obstetrics and Gynecology

摘　　要：目的:探索Ⅱ型及Ⅲ型剖宫产子宫瘢痕处妊娠(CSP)经腹腔镜下子宫动脉临时阻断辅助治疗后近远期临床效果。方法:回顾分析2016年1月至2021年6月在苏州大学附属第一医院治疗的88例Ⅱ型及Ⅲ型CSP患者的临床资料。40例患者行预防性子宫动脉栓塞术+超声引导下清宫术(对照组),48例患者行腹腔镜下临时动脉阻断术+腹腔镜监视下清宫术(腹腔镜组),有生育要求患者行瘢痕修补术。比较2组患者术后近期和远期并发症发生率,并记录再次妊娠情况。结果:腹腔镜组术前与术后血红蛋白差值、住院时间、并发症人次数均显著低于对照组,差异均有统计学意义(P<0.05)。腹腔镜组、对照组中术后主诉月经减少者分别有15例(31.3%)和21例(52.5%),其中对照组有1例出现卵巢早衰,差异有统计学意义(P<0.05)。再次妊娠时,腹腔镜组的异常妊娠率明显低于对照组,差异有统计学意义(P<0.05)。结论:腹腔镜下子宫动脉临时阻断辅助治疗是一种安全可靠的治疗方式,术中出血量较少,术后并发症较少,异常妊娠率较低。Objective:To investigate short-term and long-term clinical effects of laparoscopic uterine artery temporary occlusion assisted uterine curettage on the treatment of typeⅡorⅢcesarean scar pregnancy(CSP).Methods:The clinical data of 88 patients with typeⅡorⅢCSP in the First Affiliated Hospital of Soochow University from January 2016 to June 2021 were analyzed retrospectively.40 patients were selected as the control group and then treated with uterine artery embolization in addition to ultrasound-guided uterine curettage.48 patients were selected as the laparoscopic group,and thus treated with laparoscopic uterine artery temporary occlusion assisted uterine curettage and additional scar repair with fertility requirements.The short-term and long-term complication rate and re-pregnancy status were compared between the two groups.Result:The preoperative and postoperative hemoglobin bias,the length of stay,number of complications in the laparoscopic group were significantly lower than those in the control group(all P<0.05).There were 15 cases(31.3%)of spanomenorrhea in the laparoscopic group,which was lower than that in control group[21 cases(52.5%)]accompanied by a 1 case of premature ovarian failure(P<0.05).When re-pregnancy occurred,abnormal pregnancy rate in the laparoscopic group was significantly lower than that in the control group(P<0.05).Conclusions:Compared with UAE,laparoscopic uterine artery temporary occlusion assisted treatment has the advantages of a little intraoperative bleeding,lower postoperative complication rate,and lower abnormal re-pregnancy rate.It is a safe and effective method worthy of clinical popularization.

关 键 词：瘢痕妊娠 子宫动脉临时阻断 近远期 再次妊娠 

分 类 号：R714.2[医药卫生—妇产科学]