B超引导下吸宫治疗内生型瘢痕妊娠

Treatment of endogenous cesarean scar pregnancy with ultrasound-guided suction curettage

目的：回顾性研究内生型瘢痕妊娠在B超引导下行吸宫治疗的安全性和有效性。方法回顾近5年在首都医科大学宣武医院诊断的内生型瘢痕妊娠患者共68例，其中46例在B超引导下行吸宫术，22例行宫腔镜检查术，分别从术中成功率、出血量、hCG恢复正常时间、住院总花费等方面进行分析。结果46例行B超引导下吸宫术，44例成功，2例失败，成功率95．7％；22例行宫腔镜检查术，21例成功，1例失败，成功率95．5％；术中出血量吸宫术组为（89．4±58．3）ml，宫腔镜组为（175．1±69．3）ml；手术时间吸宫术组为（19．2±6．4）min，宫腔镜组（35．4±17．2）min；术后血hCG恢复正常时间吸宫术组为（58．0±21．2）d，宫腔镜组为（46．2±12．4）d；住院费用吸宫术组为（1545．3±437．2）元，宫腔镜组（5893．0±1785．4）元。两组相比，成功率无显著差异，吸宫术组术中出血量少、手术时间短、住院总花费低，但hCG恢复时间稍长。结论采用B超引导下吸宫术治疗内生型瘢痕妊娠是一种安全、有效，损伤小、花费少的治疗方法。

Objective To retrospectively analyze safety and feasibility of the suction curettage in the treatment of endogenous scar pregnancy guided with ultrasound. Methods We included sixty-eight patients diagnosed as endogenous cesarean scar pregnancy at Xuanwu Hospital,Capital Medical University in the past five years.Forty-six patients treated with suction curettage guided with ultrasound,another twenty-two patients treated with hysteroscopy.We compared the outcomes of the two groups with success rate,the bleeding volume,time for β-hCG returning to normal,and the total cost of inpatient. Results Of the forty-six patients underwent curettage guided with ultrasound,forty-four patients achieved success,another two failed.The success rate was 95.7%.Of the twenty-two patients treated with hysteroscopy,one failed,and the remaining twenty-one were successful.The success rate was 95.5%.Average blood loss during suction curettage was （89.4 ±58.3）ml,while the hysteroscopy group was （1 75.1 ±69.3）ml.Mean time for achieving a normalβ-hCG level was （58.0 ±21 .2）days for the suction curettage group,and （46.2 ±1 2.4）days for the hysteroscopy group. Total cost of inpatient was （1 545.3 ±437.2）yuan for the suction curettage group,and （5 893.0 ±1 785.4 ）yuan for the hysteroscopy group.We found no statistically significant difference in the success rate between the two groups.Compared with hysteroscopy group,the suction curettage group had less blood loss,shorter operation time,lower cost of inpatient,but longer time for serum β-hCG returning normal levels. Conclusion Suction curettage guided by ultrasound is a safe and effective method,with low damage and cost.