腹腔镜下暂时阻断髂内动脉在子宫瘢痕妊娠中的临床研究

Clinical study of laparoscopic temporary occlusion of internal iliac artery in uterine scar pregnancy

目的探讨腹腔镜下双侧髂内动脉暂时性阻断下剖宫产瘢痕妊娠病灶清除术+修补术的临床研究。方法回顾性研究2017年2月至2018年10月期间河南省人民医院妇科收治剖宫产瘢痕部位妊娠患者60例,其中A组30例,II^III型子宫瘢痕妊娠患者选用腹腔镜下双侧髂内动脉暂时性阻断下行剖宫产瘢痕部位病灶清除术+修补术治疗,B组30例,选用传统介入子宫动脉栓塞术后+清宫术治疗,比较两组患者出血量、住院时间、住院费用、术后月经复潮时间及再次妊娠结局等情况。结果A组手术出血量[(38.5±22.0)mL]、住院时间[(4.2±1.5)d]、住院费用[(21720±685)元]与B组[(100.0±25.0)mL、(5.6±2.2)d、(28756±980)元]比较,差异有统计学意义(P=0.006、0.008、0.019)。两组术后血人绒毛膜促性腺激素(hCG)下降率、月经恢复时间等相比较,差异均无统计学意义(P>0.05)。结论腹腔镜下双侧髂内动脉暂时性阻断下行剖宫产瘢痕部位病灶清除术+修补术治疗剖宫产妊娠优于传统介入子宫动脉栓塞术后+清宫术,疗效确切、手术创伤小、相比较介入治疗手术费用较低等优点,提高术后再次妊娠率及分娩率、降低再次瘢痕妊娠率,是治疗子宫瘢痕妊娠的较理想方法,值得临床推广。

Objective To investigate the therapeutic effect of laparoscopic bilateral internal iliac artery temporary occlusion on cesarean section scar pregnancy.Methods Retrospective research was performed in 60 cases of cesarean scar pregnancy who were treated in Gynecology Department of Henan Provincial People’s Hospital from February 2017 to October 2018.Among them,30 cases in group A were treated by type II-III of laparoscopic bilateral internal iliac artery temporary occlusion followed by cesarean scar lesion clearance and repair,30 cases in group B were treated by traditional interventional uterine artery embolization plus clearance.The bleeding volume,hospitalization time,hospitalization expenses,the time of menstruation after operation and the outcome of secondary pregnancy were compared between the two groups.Results Group A had less bleeding[(38.5±22.0)mL],shorter hospitalization time[(4.2±1.5)d],less hospitalization expenses[(21720±685)yuan]compared with group B[(100.0±25.0)mL,(5.6±2.2)d,(28756±980)yuan],the results were all statistically significant(P<0.05).There were no significant differences in the reduction rate of human chorionic gonadotrophin(hCG)and the recovery time of menstruation between the two groups(P>0.05).Conclusion Laparoscopic excision and repair of scar site of cesarean section under temporary bilateral internal iliac artery occlusion is superior to traditional interventional uterine artery embolization plus uterine curettage in the treatment of cesarean section pregnancy.It has the advantages of exact curative effect,less surgical trauma and lower cost compared with interventional therapy.It can improve the rate of re-pregnancy after operation.It is an ideal method to treat uterine scar pregnancy by improving the rate of secondary pregnancy,delivery rate of secondary pregnancy and reducing the rate of secondary scar pregnancy.It can improve the treatment level of scar pregnancy and is worth popularizing.