清宫术治疗剖宫产瘢痕妊娠的临床疗效:一项随机对照试验  

Clinical efficacy of curettage in treating cesarean scar pregnancy:a randomized controlled trial

作　　者：杨颖 周潞 罗莉 熊希 陈正琼 YANG Ying;ZHOU Lu;LUO Li;XIONG Xi;CHEN Zhengqiong(Department of Obstetrics and Gynecology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院妇产科,重庆

出　　处：《陆军军医大学学报》2025年第9期989-994,共6页Journal of Army Medical University

基　　金：应用基础研究项目(2021)。

摘　　要：目的对比清宫术与联合子宫动脉栓塞术(uterine artery embolization,UAE)治疗超声量化评分系统下低评分(≤4分)剖宫产瘢痕妊娠(cesarean scar pregnancy,CSP)患者的安全性和有效性。方法根据本随机对照研究设计的纳排标准,选取2020年5月至2023年8月在陆军军医大学第二附属医院妇产科门诊经超声量化评分≤4分的CSP患者,按照1∶1比例采用随机数字表法将参与者分为2组,分别为清宫组(n=48)和UAE联合清宫组(UAE+清宫组,n=47)。收集2组患者的一般情况、术中情况、术后3个月内补救措施的使用情况、随访患者的妊娠结局及对患者恢复正常月经后经量的变化产生的影响,随访日期截止至2024年10月。结果清宫组与UAE+清宫组患者均完成随访,一般情况中除妊娠囊最大径线之外的基线数据对比无统计学差异,清宫组比UAE+清宫组有更多的妊娠囊最大径线≤25 mm患者[37(77.1%)vs 27(57.4%),P<0.05]。2组患者的清宫术中出血量、术后补救措施的使用情况差异无统计学意义。UAE+清宫组比清宫组有更多的恢复正常月经后经量减少患者[30(63.8%)vs 13(27.1%),P<0.001]。2组的妊娠结局及恢复月经的天数差异无统计学意义。结论对比清宫术联合UAE治疗超声量化评分系统≤4分的CSP患者,清宫术的治疗效果无明显差异,其有效性和安全性均较高。Objective To compare the safety and efficacy of curettage and their combination with uterine artery embolization(UAE) in the treatment of cesarean scar pregnancy(CSP) patients with a low score(≤4) in the ultrasound quantification scoring system. Methods Based on our inclusion and exclusion criteria of this randomized controlled study, the women with CSP who had an ultrasonic quantitative score ≤4and were treated in our department from May 2020 to August 2023 were enrolled, and then randomly divided into a curettage group(n=48) and a UAE combination group(n=47) in a ratio of 1∶1. General information,intraoperative conditions, and use of rescue measures within 3 months after operation were collected in the 2 groups of patients. All the patients were followed up until October 2024 to observe the pregnancy outcomes and determine the impact on the menstrual volume after the resumption of normal menstruation.Results The patients from the both groups completed the follow-up. Except for the maximum gestational sac diameter, there were no significant differences in other baseline data between the 2 groups, and the curettage group had notably more patients having a gestational sac diameter ≤25 mm than the combination group [37(77. 1%) vs 27(57. 4%), P<0. 05]. No statistical differences were observed between the 2 groups in the intraoperative bleeding volume and use of rescue measures within 3 months after surgery. The combination group had obviously more patients with reduced menstrual volume after the resumption of normal menstruation than the dilation and curettage group [30(63. 8%) vs 13(27. 1%), P<0. 001]. There were no statistically differences in pregnancy outcomes and the number of days to resume menstruation between the 2 groups.Conclusion For CSP patients with a score of ≤4 in the ultrasound quantification scoring system, curettage show no significant difference in therapeutic effectiveness, and even have better efficacy and safety when compared with curettage combined with UAE.

关 键 词：剖宫产瘢痕妊娠 清宫术 联合子宫动脉栓塞术 超声量化评分系统 

分 类 号：R619.6[医药卫生—外科学] R713.41[医药卫生—临床医学] R714.22