可逆性子宫动脉结扎术在Ⅱ型及Ⅲ型子宫瘢痕处妊娠中的应用研究  

Study on the application of reversible uterine artery ligation in typeⅡandⅢcesarean scar pregnancy

作　　者：范忆滢 何扬舟 张伟峰 FAN Yiying;HE Yangzhou;ZHANG Weifeng(NBU Health Science Center,Zhejiang Ningbo 315000,China;Department of Gynecology,Ningbo Women and Children s Hospital,Zhejiang Ningbo 315000,China)

机构地区：[1]宁波大学医学部,浙江宁波315000 [2]宁波市妇女儿童医院妇科,浙江宁波315000

出　　处：《中国妇幼健康研究》2024年第12期80-85,共6页Chinese Journal of Woman and Child Health Research

基　　金：宁波市妇科疾病临床医学研究中心(2024L002)。

摘　　要：目的探讨腹腔镜下可逆性子宫动脉结扎用于Ⅱ型及Ⅲ型子宫瘢痕处妊娠(CSP)的可行性和安全性。方法回顾性分析2020年1月至2022年12月期间,在宁波市妇女儿童医院接受手术治疗的Ⅱ型或Ⅲ型子宫瘢痕处妊娠病例,选择其中行宫腹腔镜联合手术,且术中行可逆性子宫动脉结扎术的28例作为研究对象。术中首先行腹腔镜下可逆性子宫动脉结扎术,然后再行瘢痕处妊娠物清除、瘢痕组织切除和修复手术。分析比较Ⅱ型与Ⅲ型患者的手术时间、术中出血量、并发症等围手术期情况,以及术后24小时血清人绒毛膜促性腺激素(β-hCG)下降情况、再次妊娠情况等手术结局。结果本研究CSP患者年龄(35.03±5.51)岁,停经时间平均(54.48±15.34)天,治疗前血清β-hCG平均(114148.69±80957.08)mIU/mL;分型情况为Ⅱ型19例,Ⅲ型9例,两组一般临床资料比较差异无统计学意义(P>0.05)。28例患者中27例顺利完成手术,术中平均出血量(174.19±145.48)mL,手术时间(136.30±39.56)min,术后24小时血清β-hCG下降(62.44±14.80)%;1例患者尽管已行子宫动脉结扎,但在宫腔镜下行妊娠物清除时,仍然出现阴道持续大量流血,经宫腔球囊填塞后出血停止,共出血1200mL;所有患者均未出现膀胱损伤等严重并发症;Ⅲ型CSP患者术中出血量、手术时间大于Ⅱ型患者,差异有统计学意义(t值分别为2.243、3.381,P<0.05),其余手术指标差异无统计学意义(P>0.05)。经平均(26.71±9.28)个月的随访,8例有再生育意愿的患者中,有2例再次妊娠,其中1例患者足月剖宫产,1例患者再次发生子宫瘢痕处妊娠。结论腹腔镜下可逆性子宫动脉结扎术用于Ⅱ型及Ⅲ型子宫瘢痕处妊娠安全有效,可作为子宫动脉栓塞的一种替代方法,但对于β-hCG高、包块大、胎心阳性、影像学检查提示胎盘植入者需慎重。Objective To investigate the feasibility and safety of laparoscopic reversible uterine artery ligation for typeⅡorⅢcesarean scar pregnancy(CSP).Methods A retrospective analysis was performed for the typeⅡorⅢcesarean scar pregnancy cases treated with surgery at Ningbo Women and Children s Hospital from January 2020 to December 2022,and 28 cases of typeⅡorⅢcesarean scar undergoing intraoperative laparoscopic surgery and reversible uterine artery ligation were selected as the study subjects.During the operation,laparoscopic reversible uterine artery ligation was performed first,followed by scar removal of the scarred pregnancy,excision and repair of scar tissue.The operation time,intraoperative blood loss,complications and other perioperative conditions,as well as the decrease in serum human chorionic gonadotropin(β-hCG)24 hours after operation and the recurrence of pregnancy in patients with typeⅡand typeⅢwere analyzed and compared.Results In this study,the average age of CSP patients was 35.03±5.51 years,the average duration of menstruation was 4.48±15.34 days,and the average serumβ-hCG level before treatment was 114148.69±80957.08 mIU/mL.There were 19 cases of typeⅡand 9 cases of typeⅢ.There was no significant difference in general clinical data between the two groups(P>0.05).The Among the 28 patients,27 patients successfully completed the operation,with an average intraoperative blood loss was 174.19±145.48 mL,the operation time was 136.30±39.56 min,and the serumβ-hCG decreased by 62.44±14.80%24 hours after the operation.In one patient,despite uterine artery ligation,there was continuous heavy vaginal bleeding during hysteroscopic removal of the pregnancy product,and the bleeding stopped after balloon tamponade,with a total bleeding of 1200 mL.None of the patients had serious complications such as bladder injury.There was a statistically significant difference in the intraoperative blood loss and operation time of typeⅢCSP patients compared with typeⅡpatients(t=2.243,3.381,P<0.05

关 键 词：子宫动脉结扎 子宫瘢痕处妊娠 可逆性 腹腔镜 

分 类 号：R173[医药卫生—妇幼卫生保健]