超声介入下聚桂醇辅助清宫术在剖宫产后子宫瘢痕妊娠患者治疗中的应用效果观察

Effect of ultrasound intervention Lauromacrogol assisted curettage in the treatment of scar pregnancy after cesarean section

目的:观察术前超声介入下聚桂醇硬化辅助清宫术治疗Ⅰ型、Ⅱ型剖宫产后子宫瘢痕妊娠患者中的应用效果。方法:选择2017年8月-2021年12月天台县人民医院收治的剖宫产后子宫瘢痕妊娠Ⅰ、Ⅱ型患者共62例,根据术前预处理方式将患者分为研究组(n=30)和对照组(n=32)。研究组采用术前超声介入下聚桂醇硬化预处理后行清宫手术,对照组采用术前子宫动脉栓塞治疗后行清宫手术,比较两组的相关指标。结果:①研究组患者手术时间、住院时间,住院费用均少于对照组,差异有统计学意义(P<0.05);两组术中出血量、术后1d血β-HCG下降率、血β-HCG转阴时间、月经恢复时间比较,差异无统计学意义(P>0.05)。②研究组根据Adler分级标准细分为少血供组和富血供组,富血供组术前血β-HCG水平高于少血供组,差异有统计学意义(P<0.05)。但两组CSP分型差异、停经时间、孕囊直径、术中出血量比较,差异无统计学意义(P>0.05)。结论:采用术前超声介入下聚桂醇硬化对Ⅰ型、Ⅱ型CSP患者进行预处理,更能预防大出血、减轻患者经济负担、促进快速恢复,同时辅助清宫术治疗可被具备超声介入条件的基层医院应用。

Objective To investigate the effect of preoperative ultrasound intervention in the treatment of uterine scar pregnancy after type I and type II c-section scar pregnancy.Methods Analysis of 62 patients with uterine scar pregnancy type I and II after cesarean section at People’s Hospital of Tiantai County from August 2017 to December 2021.The included patients were divided into a study group and a control group based on preoperative pretreatment methods.The study group was treated with preoperative ultrasound intervention and then underwent curettage surgery.The control group was treated with preoperative uterine artery embolization and then underwent curettage surgery.The efficacy and other parameter differences between the two groups were compared.Results①There was a statistically significant difference in surgical time,hospitalization time,and hospitalization costs between the two groups of patients(β-HCG) decline rate after one day of treatment.There was a statistically significant difference in the time between HCG negative conversion and menstrual recovery(P<0.05).②The study group was subdivided into two groups based on Adler’s grading criteria:the low blood supply group and the high blood supply group,and the preoperative blood was compared between the high blood supply group and the low blood supply group.β-HCG was significantly increased in the low blood supply group,with a statistically significant difference(P<0.05).However,there was statistically non-significant difference between the two groups in terms of blood supply and CSP typing,menopausal time,gestational sac diameter,and bleeding volume(P>0.05).Conclusion Pre-treatment of patients with type I and type II CSP with Lauromacrogol sclerotherapy under preoperative ultrasound intervention can prevent massive bleeding,reduce the economic burden of patients,and promote rapid recovery.At the same time,assisted curettage can be promoted by grass-roots hospitals with ultrasound intervention conditions.